Generic erosion will bite into the acute coronary syndrome market, cutting sales nearly 10% from 2008 to 2018

Generic erosion of premium-priced branded agents will offset sales of new agents and will cause the acute coronary syndrome market for drugs in the hospital setting to decrease from $800 million in 2008 to $729 million in 2018 in the USA, France, Germany, Italy, Spain, the UK and Japan, says a new report from research and advisory firm Decision Resources.

The new Pharmacor report, entitled Acute Coronary Syndrome, finds that, through 2018, the patent expiries of Merck & Co/GlaxoSmithKline's Integrilin (eptifibatide), Merck/Medicure's Aggrastat (tirofiban) and Sanofi-Aventis's Lovenox/Clexane (enoxaparin) will be the key factors constraining the market. Among these agents, generic erosion of Integrilin will be the most significant as its sales will decrease by around $100 million from 2008 to 2018. However, Merck will recoup some of these losses with the 2011 launch of its adenosine agonist, Acadesine, which is expected to be the first agent to receive regulatory approval for reperfusion injury.

Strong prospects for Brilinta

The most advanced agent in development, AstraZeneca's Brilinta (ticagrelor), is the most likely emerging therapy to change medical practice for acute coronary syndrome. In a Phase III clinical trial, Brilinta significantly reduced the risk of mortality compared with clopidogrel (Bristol-Myers Squibb/Sanofi-Aventis's Plavix/Iscover, generics), which has been a mainstay in the treatment of acute coronary syndrome. Following its launch next year, Brilinta sales in 2010 are forecasted to reach $21 million in the acute treatment setting, although it has blockbuster potential for treatment of post-myocardial infarction.

The report also finds that, owing to demonstrated clinical benefit over unfractionated heparin in large-scale clinical trials, several anticoagulants will capture patient share in the percutaneous coronary intervention (PCI) setting.

"We expect higher-priced anticoagulants, such as The Medicines Company's Angiomax/Angiox (bivalirudin) and Sanofi-Aventis's emerging agent otamixaban to gradually capture share in PCI-treated patients at the expense of unfractionated heparin," said Decision Resources director Nikhil Mehta, adding: "This trend, particularly the uptake of otamixaban, will contribute to a three percent annual sales growth of anticoagulants through 2018, making anticoagulants one of the few drug classes to experience market expansion over the next decade.'