REFERENCE CODE GDHC357DFR PUBLICAT ION DATE FEBRUARY 2014 CLOZARIL (SCHIZOPHRENIA)
Executive Summary Clozaril: Key Metrics in the Seven Major Pharmaceutical Markets, 2012 2022 2012 Market Sales US 5EU Japan Total 2022 Market Sales US 5EU Japan 7MM Source: GlobalData. $322.3m $11.7m $57.0m $390.9m $267.5m $9.7m $36.8m $314.0m 7MM = US, France, Germany, Italy, Spain, UK, Japan; 5EU = France, Germany, Italy, Spain, UK The table above provides a summary of the key metrics for Clozaril in the seven major pharmaceutical markets during the forecast period from 2012 2022. Effective in reducing suicidal ideation in patients with schizophrenia The key factors that will lead to the decline in sales are: Risks of potentially fatal agranulocytosis Poor overall tolerability Requires strict monitoring of patients The figure below illustrates Clozaril in the 7MM by region during the forecast period. Sales for Clozaril by Region, 2012 2022 2012 Total: $390.9m 14.6% 3.0% Sales of Clozaril in Global Schizophrenia Market, 2012-2022 The sales of Clozaril were estimated at $390.9 millions in 2012. By 2022, GlobalData projects these sales to decline marginally to $314.0 millions, with a negative compound annual growth 2022 Total: $314.0m 11.7% 3.1% 82.4% US 5EU Japan rate (CAGR) of 2.17% over the course of the decade. These estimates cover the sales in the seven major markets (7MM) included in this report: the US, France, Germany, Italy, Spain, the UK, and Japan. We believe that the following parameters will drive expansion in these markets: Source: GlobalData. 85.2% Effective in treatment-resistant patients with schizophrenia Clozaril (Schizophrenia) Forecast and Market Analysis to 2022 2
Executive Summary What Do the Physicians Think? Unfortunately there is really nothing out there which would give me confidence that we will have something reasonably effective in the next several years. We are probably coming to one set of results very soon, probably sometime early next year or maybe the spring of next year, the glutamatergic compounds. [US] KOL, October 2013 There isn t that much coming out these days, so that s a fact which many of us have actually agreed on is a major, major issue. We ve had discussions with pharmaceutical companies as a group of pharmacologically oriented and research-oriented psychiatrists and say, Please come back and reactivate your research and development sections and divisions. Don t desert this group of patients, because we need better drugs. There s no doubt about it. [We] treat them according to the presenting syndrome. And even more specifically in terms of the positive symptoms, depression, affective symptoms, or cognitive symptoms, negative symptoms they will be cueing in much more on that rather than on the label of, Is this schizoaffective, is it bipolar, is it a schizophrenic patient? I think once it gets down to medications, then it gets much simpler. These discussions do not reach into the medication decision-making process. [EU] KOL, December 2013 Going systematically, you have the glutamatergic compounds, you have nicotinic acid agonists, you have the me-too drugs, which are the D 2 /5-HT 2 antagonists, and of those we have plenty, we don t need anything more, that mechanism of action is entirely taken care of, so to speak. [US] KOL October, 2013 [US] KOL, September 2013 If you look at the utilization patterns of antipsychotics you do see that once the atypicals were introduced, the usage of these medications went up significantly. And this is not at all because there are more schizophrenic patients around. In fact, schizophrenia has actually decreased slightly in terms of epidemiology. But they have increased in terms of rate of prescribing because the diagnosis has expanded to which these medications are directed to. [EU] KOL, November 2013 3
Table of Contents 1 Table of Contents 1 Table of Contents... 4 1.1 List of Tables... 6 2 Introduction... 7 2.1 Catalyst... 7 2.2 Related Reports... 8 2.3 Upcoming Reports... 9 3 Disease Overview... 10 3.1 Etiology and Pathophysiology... 10 3.1.1 Etiology... 10 3.1.2 Pathophysiology... 11 3.2 Symptoms... 12 4 Disease Management... 13 4.1 Diagnosis... 13 4.1.1 Subjective Assessments... 14 4.1.2 Disease Subtypes... 15 4.2 Treatment Overview... 18 4.2.1 Treatment of Acute Agitation Associated with Schizophrenia... 20 4.2.2 Maintenance Treatment of Schizophrenia... 21 5 Competitive Assessment... 22 5.1 Overview... 22 5.2 Strategic Competitor Assessment... 23 6 Clozaril (clozapine)... 25 6.1 Overview... 25 6.2 Efficacy in Treatment-Resistant Schizophrenia... 26 4
Table of Contents 6.3 Safety... 26 6.4 SWOT Analysis... 26 6.5 Forecast... 27 7 Appendix... 28 7.1 Bibliography... 28 7.2 Abbreviations... 30 7.3 Methodology... 31 7.4 Forecasting Methodology... 31 7.4.1 Diagnosis and Treatment Rates... 31 7.4.2 Adherence Rates... 32 7.4.3 General Pricing Assumptions... 32 7.4.4 Drug Assumptions... 33 7.4.5 Generic Erosion... 34 7.5 Key Opinion Leaders... 35 7.6 About the Authors... 36 7.6.1 Author... 36 7.6.2 Reviewers... 36 7.6.3 Global Head of Healthcare... 37 7.7 About GlobalData... 38 7.8 Disclaimer... 38 5
Table of Contents 1.1 List of Tables Table 1: Symptom Clusters of Schizophrenia... 12 Table 2: Common Subjective Rating Scales Employed in Schizophrenia Diagnosis... 15 Table 3: Development-Based Classification of Antipsychotic Drugs... 18 Table 4: Receptor Binding Profiles of Atypical Antipsychotics... 19 Table 5: Guidelines for the Treatment of Schizophrenia... 20 Table 6: Leading Branded Treatments for Schizophrenia, 2013... 24 Table 7: Strategic Competitor Assessment of the Marketed Products in Schizophrenia, 2014... 24 Table 8: Product Profile Clozaril... 25 Table 9: Clozaril SWOT Analysis, 2014... 26 Table 10: Global Sales Forecast ($m) for Clozaril, 2012 2022... 27 6
Introduction 2 Introduction 2.1 Catalyst Schizophrenia is a chronic, severe, and disabling group of psychotic disorders characterized by fundamental disturbances of thinking such as hallucinations, delusions, disorganized communication and reduced motivation (NIMH, 2013; WHO, 2013). Globally, the condition is prevalent in approximately 7 persons per 1,000 of the adult population ages 15 35 years (WHO, 2013). This report provides an overview of the risk factors, comorbidities, and the global and historical trends for schizophrenia in the seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan). In addition, the report also includes a 10-year forecast of diagnosed prevalent cases of schizophrenia segmented by age and sex. To forecast the diagnosed prevalent cases of schizophrenia in the 7MM, GlobalData epidemiologists selected nationally representative studies that provided diagnosed prevalence of schizophrenia using uniform diagnostic criteria and classification defined by the World Health Organization s International Classification of Diseases 9th revision (ICD-9). GlobalData epidemiologists forecast an increase in the diagnosed prevalent cases of schizophrenia in the 7MM from 2,495,903 diagnosed prevalent cases in 2012 to 2,643,660 diagnosed prevalent cases in 2022, with an annual growth rate (AGR) of 0.59% in the forecast period. In 2022, the US will have the highest number of diagnosed prevalent cases of schizophrenia with 1,777,333 diagnosed prevalent cases, followed by Japan with 454,961 diagnosed prevalent cases, and Italy with 154,331 diagnosed prevalent cases. 7
Introduction 2.2 Related Reports GlobalData (2014). PharmaPoint: Schizophrenia Global Drug Forecast and Market Analysis to 2022 GlobalData (2014). Schizophrenia US Drug Forecast and Market Analysis to 2022, February 2014, GDHC224CFR GlobalData (2014). Schizophrenia 5EU Drug Forecast and Market Analysis to 2022, February 2014, GDHC225CFR GlobalData (2014). Schizophrenia Japan Drug Forecast and Market Analysis to 2022, February 2014, GDHC226CFR GlobalData (2014). Abilify (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC355DFR GlobalData (2014). Saphris (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC356DFR GlobalData (2014). Fanapt (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC358DFR GlobalData (2014). Latuda (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC359DFR GlobalData (2014). Zyprexa (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC360DFR GlobalData (2014). Invega (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC361DFR GlobalData (2014). Seroquel (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC362DFR GlobalData (2014). Risperdal (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC363DFR 8
Introduction GlobalData (2014). Geodon (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC364DFR GlobalData (2014). Aripiprazole lauroxil (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC365DFR GlobalData (2014). Cariprazine (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC366DFR GlobalData (2014). Brexpiprazole (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC367DFR GlobalData (2014). Zicronapine (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC368DFR GlobalData (2014). Bitopertin (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC369DFR GlobalData (2014). EVP-6124 (Schizophrenia) Forecast and Market Analysis to 2022, February 2014, GDHC370DFR GlobalData (2014). EVP-6124 (Schizophrenia) Current and Future Players, February 2014, GDHC1030FPR 2.3 Upcoming Reports GlobalData (2014). PharmaPoint Report: Major Depressive Disorders, 2014 9
Appendix 7.7 About GlobalData GlobalData is a leading global provider of business intelligence in the Healthcare industry. GlobalData provides its clients with up-to-date information and analysis on the latest developments in drug research, disease analysis, and clinical research, and development. Our integrated business intelligence solutions include a range of interactive online databases, analytical tools, reports, and forecasts. Our analysis is supported by a 24/7 client support and analyst team. GlobalData has offices in New York, Boston, London, India, and Singapore. 7.8 Disclaimer All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher, GlobalData. 38