Based on IQVIA’s Forecast Link, this article considers how the glaucoma market is expected to develop over the next 10 years, and how new product launches and generic entries are expected to shape market evolution.
Glaucoma is a progressive disease that damages the optic nerve and is the leading cause of irreversible blindness. By the end of 2020, approximately 76 million people globally will have the disease and this number is expected to increase to 112 million by 2040.1Currently, treatment focusses on lowering intraocular pressure (IOP) which can be achieved via pharmacological, laser and surgical approaches. Pharmacological therapy for glaucoma primarily involves the instillation of eye drops with drugs that reduce aqueous humor production or enhance its drainage through various outflow pathways. However, current pharmacological therapies possess significant drawbacks.2Topical ophthalmic administration can result in enough systemic absorption to produce serious side effects and these can be life-threatening in some cases. Furthermore, treatment adherence is one of the most significant challenges in the management of glaucoma and results from intolerable side effects and poor installation technique, which can be exacerbated by physical limitations such as arthritis or tremor. The availability of newer products, discussed below, should help to address these limitations, but these important unmet needs have not been completely abated.
同时，使用创新的非药物治疗（例如微创青光眼手术（MIG））的使用正在上升。MIG涉及植入从前腔中排出水性幽默的装置。在过去的十年中，已有许多新设备已商业化，预计MIGS设备市场将在2020年至2027年之间以大约31.7％的复合年增长率增长，到2027年，价值为3.2亿美元。3MIGS is an alternative to drug therapy and traditional glaucoma surgeries such as trabeculectomy with more rapid recovery times. In comparison, the global glaucoma pharmaceutical market is estimated to grow at a CAGR of 2% in value terms between 2020 and 2029 reaching $7.2bn by 2029 according to IQVIA’s Forecast Link. This is down from a CAGR of 4% between 2016 and 2020. Regional value growth will move similarly with the exceptions of Europe and AUNZ, where the availability of new therapies will increase value growth above recent historical trends, and Japan, where price controls such as biennial price cuts will continue to have a negative impact.
Value growth will be impacted by slowing volume growth in terms of patient days (PATDAY) between 2020 and 2029. In the AUNZ region, historical volume growth was in fact negative and this has been directly attributed to a shift towards surgical and laser management of glaucoma.4The growth rate in PATDAYs is expected to decelerate across all regions apart from AUNZ where new pharmacological therapies will restore positive prescription demand for drugs modestly. The uptake of surgical interventions such as MIGS is assumed to be captured in the baseline PATDAY volume trends since they have been available for many years and are undergoing incremental improvements.
尽管手术选择越来越受欢迎，并且越来越早使用，但关于其成本效益以及长期结局是否优于药物疗法的问题仍然存在。此外，手术选择不能治愈该疾病，并且仅提供局部性眼科制剂的暂时缓解。结果，眼滴将仍然是青光眼的重要治疗选择。直到2017年底，基于行动机制，在过去的二十年中，在青光眼市场没有创新的新药推出。然而，从那时起，已经推出了五种新产品，试图满足未满足的需求，预计它们将在2020年至2029年之间在更多的地理中推出。
除了这些新产品发布之外，预计在2020年至2029年之间，预计八个分子会损失保护（LOP）事件（LOP），开放市场以增加通用竞争。总体而言，估计这些分子在2020年将占全球青光眼价值销售的14亿美元或23％。但是，由于几个原因，新产品的推出将抵消损失。首先，在某些情况下，与现有治疗相比，它们具有较高的功效。其次，有些具有创新的作用机制，这意味着它们为对现有疗法无反应的患者提供了另一种治疗方法。第三，这些药物的轻度副作用曲线为与其他产品产生无法忍受的副作用的患者提供了其他选择。第四，该植入物为不遵守或发现眼滴的患者提供了替代方案，这是由于身体上的限制而无法管理的。新产品每天的平均隐含成本是现有疗法的8倍，因此，全球范围内以及整个地区的净积极影响和LOP事件的净积极影响。
在大多数地区，发射和LOP事件的净影响以及青光眼的上升率上升将在2020年至2029年之间在药物市场上促进正数和价值增长，但是手术干预措施已越来越受欢迎，并以前被用作控制这种手段疾病。非药理学干预措施限制了药理学治疗的体积生长，但是在治愈或长期溶液实现之前，药物治疗将仍然是青光眼患者的重要治疗选择。幸运的是，这两个领域的进步正在改善这种令人衰弱的疾病患者的生活质量。
1Tham YC, Li X, Wong TY, et. al. Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis. Ophthalmology. 2014 Nov;121(11):2081-90.
2Lusthaus J, Goldberg I. Current management of glaucoma. Med J Aust. 2019 Mar;210(4):180-187. doi: 10.5694/mja2.50020. Epub 2019 Feb 14. PMID: 30767238.
3Market Analysis and Insights: Global Micro Invasive Glaucoma Surgery (MIGS) Devices Market
4Skalicy S和White A.青光眼研究：一年的进步（2018年3月）。https://glaucoma.org.au/news-details/research/glaucoma-research-a-年度
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