The urticaria drug market is dominated by oral medications, including steroids and second-generation, nondrowsy antihistamines, prescribed for both chronic inducible and chronic spontaneous urticaria. However, both drug classes have serious side effects, and many patients still struggle to control their lesions. As a result, the approval of Xolair has been welcomed by physicians and patients. Clinical trials for additional biological therapies are underway, capturing urticaria disease data using an array of clinical scoring systems. With only one biological drug currently approved, the most important factors for driving prescribing decisions remain unknown, and many of the unmet needs in this market remain unfulfilled.

Questions answered

  • What unmet needs remain for chronic urticaria patients after the approval of Xolair?
  • Which clinical trial endpoints and nonclinical attributes are key influencers on dermatologists’ and allergists’ prescribing decisions and which have limited impact? What are potential areas of hidden opportunity?
  • How does Xolair (Novartis / Genentech), approved for chronic idiopathic urticaria in the United States, perform on key treatment drivers and goals? How does its performance compare with that of frequently prescribed conventional therapies, including steroids and antihistamines?
  • What trade-offs across different clinical attributes and price are acceptable to U.S. and European dermatologists and allergists for a hypothetical new chronic urticaria drug?

Product description

Provides quantitative insight into U.S. and European physician perceptions of key treatment drivers and goals and the current level of unmet need for a specific disease. Commercial opportunities are analyzed, and the extent to which emerging therapies may capitalize on these opportunities is evaluated.

Markets covered: United States, United Kingdom, France, Germany

Primary research: Survey of 61 U.S. and 30 European allergists and dermatologists fielded in February 2020

Key companies: Genentech, Novartis

Key drugs: Xolair, ligelizumab, steroids, antihistamines

Table of contents

  • Urticaria - Unmet Need - Detailed, Expanded Analysis (US & EU) Chronic Inducible Urticaria And Chronic Spontaneous Urticaria
    • Executive Summary
      • Unmet Need - Chronic Urticaria - Executive Summary - June 2020
    • Introduction
      • Overview
      • Methodology
      • Rationale for Treatment Drivers and Goals Selection
        • Rationale for Drug Selection
          • Products for Chronic Urticaria and Rationale for Drug Selection
      • Treatment Drivers and Goals
        • Key Findings: Attribute Importance
        • Relative Importance of Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Surveyed Dermatologists Prescribing Decisions in Chronic Urticaria
        • Importance of Efficacy Attributes to Prescribing Decisions in Chronic Urticaria: United States
        • Importance of Efficacy Attributes to Prescribing Decisions in Chronic Urticaria: Europe
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Chronic Urticaria: United States
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Chronic Urticaria: Europe
        • Importance of Convenience of Administration Attributes to Prescribing Decisions in Chronic Urticaria: United States
        • Importance of Convenience of Administration Attributes to Prescribing Decisions in Chronic Urticaria: Europe
        • Importance of Nonclinical Factors to Prescribing Decisions in Chronic Urticaria: United States
        • Importance of Nonclinical Factors to Prescribing Decisions in Chronic Urticaria: Europe
        • Key Findings: Stated vs. Derived Importance
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions in Chronic Urticaria: United States
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions in Chronic Urticaria: Europe
      • Product Performance Against Treatment Drivers and Goals
        • Overall Performance of Key Therapies for Chronic Urticaria: United States
        • Overall Performance of Key Therapies for Chronic Urticaria: Europe
        • Mean Overall Performance of Key Therapies for Chronic Urticaria: United States and Europe
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Efficacy Attributes: United States
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Efficacy Attributes: Europe
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Safety and Tolerability Attributes: United States
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Safety and Tolerability Attributes: Europe
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Convenience of Administration Attributes: United States
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Convenience of Administration Attributes: Europe
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Nonclinical Attributes: United States
        • Relative Performance of Key Therapies for Chronic Urticaria Across Select Nonclinical Attributes: Europe
      • Assessment of Unmet Need
        • Key Findings: Unmet Need in Chronic Urticaria
        • Surveyed Allergists' and Dermatologists' Satisfaction with the Performance of Key Therapies for Chronic Urticaria on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: United States
        • Surveyed Allergists' and Dermatologists' Satisfaction with the Performance of Key Therapies for Chronic Urticaria on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: Europe
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Chronic Urticaria: United States
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Chronic Urticaria: Europe
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Chronic Urticaria: United States
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Chronic Urticaria: Europe
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes in Chronic Urticaria: United States
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes in Chronic Urticaria: Europe
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors in Chronic Urticaria: United States
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors in Chronic Urticaria: Europe
        • Key Findings: Unmet Need in Chronic Urticaria and Related Indications
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need in Chronic Urticaria and Related Indications: United States
        • Surveyed Allergists' and Dermatologists' Ascribed Level of Unmet Need in Chronic Urticaria and Related Indications: Europe
      • Opportunity Analysis
        • Areas of Opportunity in the Chronic Urticaria Market and Emerging Therapy Insights
          • Opportunity: A Therapy That Can Induce Remission
          • Opportunity: A Therapy Delivering QOL Improvements
          • Opportunity: A Therapy that Decreases Urticaria Activity
      • Target Product Profiles
        • Assessing Drug Development Opportunities
        • Target Product Profile Methodology
          • Attributes and Attribute Levels
          • Attributes of Key Current and Late-Phase Emerging Therapies for Chronic Urticaria
        • Attribute Importance and Part-Worth Utilities
          • Chronic Urticaria Target Product Profile: Attribute Importance
          • Absolute Improvement in DLQI (Dermatology Life Quality Index)
          • Absolute Decrease in Weekly ISS (Itch Severity Score)
          • Absolute Decrease in UAS7 (Urticaria Activity Score, 7 Days)
          • Time to Minimally Important Difference in ISS
          • Percentage of Patients Achieving Remission Within 12 Weeks
          • Risk of Adverse Events
          • Price per Day
        • Conjoint Analysis-Based Simulation of a Market Scenario
          • Chronic Urticaria Market Simulation: Share of Preference of Target Product Profiles Included in the Market Scenario
          • Chronic Urticaria Market Simulation: Likelihood to Prescribe Target Product Profiles Included in the Market Scenario
          • Chronic Urticaria Market Simulation: Target Product Profiles Included in the Market Scenario
      • Appendix
        • Key Abbreviations
        • Experts Interviewed

    Author(s): Kristine Mackin, Ph.D.

    Kristine Mackin, Ph.D., is a principal analyst on the Immune and Inflammatory Disorders team at DRG, part of Clarivate. Her expertise includes emerging microbiome-based therapies, psoriatic arthritis, chronic obstructive pulmonary disease, and asthma. Prior to joining DRG, Dr. Mackin was involved with a new company pitch focusing on the infant microbiome, now realized as Commense, during an internship at Puretech Ventures in Boston. She holds a doctorate in biochemistry from Brandeis University, where she studied the evolution of bacteriorhodopsin and the relationship between type I and type II rhodopsins.


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