This second-time report focuses on the management of diabetic nephropathy (DN) in the United States. The U.S. market for DN drugs is poised to expand owing to the growing size of the DN patient population and the upcoming potential launches of novel therapies, such as AbbVie’s atrasentan and NephroGenex’s Pyridorin. This report provides insight into practice patterns, attitudes, and perceptions as well as current and projected use of various products used to treat DN. It also evaluates perceived aided familiarity, interest, and percentage of patients who are likely candidates by chronic kidney disease (CKD) stage for six product profiles of agents in clinical development.

Questions Answered in This Report:

  • Understand the DN patient population being treated by nephrologists, endocrinologists, and PCPs and uncover recent changes in treatment. The most common changes reported include being more aggressive with DN treatment, earlier diagnosis/increased screening/earlier referral to a nephrologist, and no longer using angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) combinations. How many patients with DN are physicians treating, and how does it compare with all patients in their practice? Do they treat more new or existing patients, and how does it differ by physician specialty? How many DN patients are in various stages of disease (microalbuminuria versus macroalbuminuria) and various stages of CKD? How quickly do DN patients progress from diagnosis to complications, and what risk factors influence progression? What are considered the gold-standard tests for diagnosing DN?

  • Understand how nephrologists, endocrinologists, and PCPs diagnose, refer, and treat patients with DN and how therapy decisions differ based on disease presentation and specialty of the treating physician. ACEI and lipid-lowering agents are commonly used by nephrologists, endocrinologists, and PCPs for patients with DN. Depending on the physician specialty, about 60% of DN patients are on ACEIs and about 60% are on lipid-lowering agents. Compared with endocrinologists and PCPs, nephrologists tend to be more likely to use ARBs, calcium-channel blockers (CCBs), diuretics, and beta blockers (BBs) in DN patients. How does preference differ for these medications by physician specialty? What is the patient share for insulin and non-insulin diabetic medications among DN patients? Which attributes are most important when choosing an agent for DN, and how does it vary by physician specialty? What are the referral patterns by physician specialty, and in what stage of CKD are patients referred from a PCP to a nephrologist?

  • Understand nephrologists’, endocrinologists’, and PCPs’ satisfaction with current DN treatments, perceived need for new treatments, and awareness of and expectations for potential for new products in development for DN. Approximately 33% of surveyed nephrologists, 16% of surveyed endocrinologists, and 18% of surveyed PCPs reported awareness of products in development that are expected to improve kidney function or delay progression of kidney dysfunction in DN patients. What is the familiarity and interest in products in development for DN, including Janssen’s Invokana, AbbVie’s atrasentan, NephroGenex’s Pyridorin, Bayer’s finerenone, ChemoCentryx’s CCX-140, and Concert Pharmaceutical’s CTP-499? What percentage of patients, by stage, are likely candidates for six profiled DN products in development? What trial end points are most important for agents in development, and which mechanisms of action hold the most promise for the treatment of DN?


Markets covered: United States.

Primary research: This report is based on a survey of 150 respondents: 51 nephrologists, 50 endocrinologists, and 49 PCPs.

Screening criteria: In practice for at least 2 and no more than 30 years and spend more than 75% of their professional time devoted to patient care as opposed to non-clinical activities such as research or teaching. In addition, respondents had to have at least 50 DN patients under their personal care.

Survey fielding dates: The physician surveys were conducted from September 2, 2014, to September 9, 2014. Surveys were completed over the Internet. Applicable prior wave trending is provided from 2012.

Report: PowerPoint format with 111 pages of content.

Author(s): Rob Dubman, M.B.A.

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