Patients with type 2 diabetes (T2D) and nephropathy, also known as diabetic nephropathy (DN), are at significant risk of developing end-stage renal disease (ESRD), a condition associated with extreme morbidity/mortality and high cost of care. Current therapies are unable to prevent progressive renal decline once initial DN sets in. As a result, physicians report substantial unmet need for safe and efficacious therapies for this indication. This unmet need represents significant commercial opportunity, one that drug developers have been quick to realize. Understanding the importance of key efficacy, safety and tolerability, and nonclinical attributes to the prescribing decisions for DN will be paramount to developing a successful therapy.

Questions Answered:

  • What are the treatment drivers and goals for DN?
  • What attributes are key influences, which have limited impact, and which are hidden opportunities?
  • How do current therapies perform on key treatment drivers and goals for DN?
  • What are the prevailing areas of unmet need and opportunity in DN?
  • What trade-offs across different clinical attributes and price are acceptable to U.S. and European endocrinologists and nephrologists for a hypothetical new DN drug?

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

Primary research: Survey of 61 U.S. and 30 European endocrinologists and nephrologists, fielded in January 2017.

Key companies: Boehringer Ingelheim, Eli Lilly, Novo Nordisk, AbbVie, Bayer HealthCare, Janssen

Key drugs: Jardiance, Victoza, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), atrasentan, finerenone, canagliflozin

Table of contents

  • Diabetic Nephropathy - Unmet Need - Detailed, Expanded Analysis
    • Key Updates
      • December 2017
      • September 2017
    • Treatment Drivers and Goals
      • Overview
      • Rationale for Treatment Drivers and Goals Selection
        • Efficacy
        • Safety and Tolerability
        • Convenience of Administration
      • Physician Rating of Treatment Drivers and Goals in Diabetic Nephropathy
        • Importance of Efficacy Attributes to Prescribing Decisions in Diabetic Nephropathy: United States
        • Importance of Efficacy Attributes to Prescribing Decisions in Diabetic Nephropathy: Europe
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Diabetic Nephropathy: United States
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Diabetic Nephropathy: Europe
        • Importance of Convenience of Administration Attributes to Prescribing Decisions in Diabetic Nephropathy: United States
        • Importance of Convenience of Administration Attributes to Prescribing Decisions in Diabetic Nephropathy: Europe
      • Stated vs. Derived Importance of Treatment Drivers and Goals
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions in Diabetic Nephropathy: United States
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions in Diabetic Nephropathy: Europe
    • Product Performance Against Treatment Drivers and Goals
      • Overview
      • Rationale for Drug Selection
        • Drug Classes/Products for Diabetic Nephropathy
      • Current Brand Performance on Key Treatment Drivers and Goals
        • Overall Performance of Key Therapies for Diabetic Nephropathy: United States
        • Overall Performance of Key Therapies for Diabetic Nephropathy: Europe
        • Relative Performance of Key Therapies for Diabetic Nephropathy Across Select Efficacy Attributes: United States
        • Relative Performance of Key Therapies for Diabetic Nephropathy Across Select Efficacy Attributes: Europe
        • Relative Performance of Key Therapies for Diabetic Nephropathy Across Select Safety and Tolerability Attributes: United States
        • Relative Performance of Key Therapies for Diabetic Nephropathy Across Select Safety and Tolerability Attributes: Europe
        • Relative Performance of Key Therapies for Diabetic Nephropathy Across Select Convenience of Administration Attributes: United States
        • Relative Performance of Key Therapies for Diabetic Nephropathy Across Select Convenience of Administration Attributes: Europe
    • Assessment of Unmet Need
      • Overview
      • Overall Satisfaction with Current Treatment
        • Surveyed Endocrinologists' and Nephrologists’ Satisfaction with the Performance of Key Therapies for Diabetic Nephropathy on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: United States
        • Surveyed Endocrinologists' and Nephrologists’ Satisfaction with the Performance of Key Therapies for Diabetic Nephropathy on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: Europe
      • Physician Rating of Unmet Need in Diabetic Nephropathy
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Diabetic Nephropathy: United States
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Diabetic Nephropathy: Europe
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Diabetic Nephropathy: United States
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Diabetic Nephropathy: Europe
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes in Diabetic Nephropathy: United States
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes in Diabetic Nephropathy: Europe
      • Unmet Need in Diabetic Nephropathy and Related Indications
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need in Diabetic Nephropathy and Related Indications: United States
        • Surveyed Endocrinologists' and Nephrologists' Ascribed Level of Unmet Need in Diabetic Nephropathy and Related Indications: Europe
    • Opportunity Analysis
      • Areas of Opportunity in the Diabetic Nephropathy Market and Emerging Therapy Insights
        • Opportunity: A Novel Agent to Prevent Progression to End-Stage Renal Disease
        • Opportunity: An Agent That Improves Cardiovascular Outcomes
        • Opportunity: A Novel Therapy Offering Improvements in eGFR
        • Opportunity: A Therapy That Enables More Patients to Reach Their Target Blood Pressure
    • Target Product Profiles
      • Assessing Drug Development Opportunities
      • Target Product Profile Methodology
        • Attributes and Attribute Levels
      • Attribute Importance and Part-Worth Utilities
        • Diabetic Nephropathy Target Product Profile: Attribute Importance
        • Reduction in Protein Urinary Excretion
        • Percentage of Patients Achieving Blood Pressure Targets
        • Risk Reduction in Delaying Onset of End-Stage Renal Disease
        • Change in Estimated Glomerular Filtration Rate per Year
        • Risk of Elevated Serum Potassium (>5.5 mmol/L)
        • Risk of Cardiovascular Events
        • Price per Day
      • Conjoint Analysis-Based Simulations of Market Scenarios
        • Diabetic Nephropathy Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 1
        • Diabetic Nephropathy Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 1
        • Diabetic Nephropathy Market Simulations: Target Product Profiles Included in Scenario 1
        • Diabetic Nephropathy Simulations: Share of Preference of Target Product Profiles Included in Scenario 2
        • Diabetic Nephropathy Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 2
        • Diabetic Nephropathy Market Simulations: Target Product Profiles Included in Scenario 2
    • Appendix
      • Key Abbreviations
      • Brands, Marketers, and Generic Availability of Key Therapies for Diabetic Nephropathy: by Market
      • Bibliography
      • Experts Interviewed

Author(s): Caitlin Koris, MSPH

Caitlin Koris, MSPH, is a business insights analyst on the cardiovascular, metabolic, and renal disorders team at Decision Resources Group. She has developed expertise in chronic kidney disease and related disorders such as bone and mineral metabolism, renal anemia, hyperkalemia, diabetic nephropathy, and kidney transplant.

Prior to joining DRG, Caitlin was a clinical research monitor for oncology phase I and II trials. She obtained her M.S. in public health/health services research (MSPH) from Emory University, where she focused on pharmacoeconomics/outcomes research and healthcare policy. She has conducted research at the U.S. Centers for Disease Control and at the Food and Drug Administration.


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