ADHD(注意欠陥多動性障害)治療の市場：処方はいまだに短時間作用型刺激薬に集中

Introduction

Despite the plethora of once-daily drugs available for the treatment of ADHD, physicians consistently prescribe immediate release formulations. To bolster revenues, manufacturers must continue to promote awareness of ADHD at all levels, but most also seek to further differentiate their once-daily products from generics and other branded products in the eyes of both the patient and the physician.

Scope of this report

• Analysis is based on a survey of 180 prescribing physicians in the seven major markets as well as in-depth interviews with ADHD Key Opinion Leaders
• Detailed treatment trees showing the prevalence, diagnosis and treatment rates of ADHD across the seven major markets
• Analyzes the first and second-line treatment of children and adolescents with ADHD
• Identifies diagnostic and therapeutic unmet needs, highlights how manufacturers can drive patient identification as well as bolster drug prescriptions

Research and analysis highlights

Datamonitor primary research has identified variances in class- and brand-prescribing preferences among physicians, although prescribing trends generally follow recognized national and international guidelines. However, there is concern over the use of combination therapies in the absence of conclusive clinical trial data.

Only 12.3% of patients are diagnosed, indicating that a huge proportion of patients remain undiagnosed and untreated. Although the awareness of ADHD is ever growing, there are still significant gaps between, knowledge, recognition and referral of the disease. Datamonitor has highlighted these and provides counteractive strategic recommendations.

Only 20% of patients receive longer-acting, once-daily drugs at first-line, falling to 3% at second-line, with physicians preferring immediate-release formulations. Consequently, Datamonitor has identified numerous lifecycle strategies to bolster long-acting drug sales.

Key reasons to read this report

• Identify commercial opportunities by benchmarking current products and assessing unmet needs and future market potential
• Assess the size of the drug-treated population through an understanding of the prevalence of ADHD with comorbid psychiatric and behavioral disorders
• Communicate with physicians more effectively, through an understanding of prescribing behavior

ABOUT DATAMONITOR HEALTHCARE

About the CNS pharmaceutical analysis team

CHAPTER 1 EXECUTIVE SUMMARY

Scope of the analysis

Datamonitor insight into the ADHD market

Key metrics

CHAPTER 2 INTRODUCTION AND SCOPE

Coverage of the Stakeholder Insight Survey

Epidemiology and diagnosis of ADHD

Referral patterns

Treatment of ADHD

Drug profiles

CHAPTER 3 COUNTRY TREATMENT TREES

US

Japan

France

Germany

Italy

Spain

UK

CHAPTER 4 EPIDEMIOLOGY & PATIENT SEGMENTATION

Key findings

Disease definition and classification

Etiology of ADHD

Structural abnormalities

Genetic predisposition

Neurotransmitter dysfunction

Diagnostic criteria of ADHD

Epidemiology of ADHD

Prevalence of ADHD

Age of onset of ADHD

Progression to adult ADHD

Key patient segments

Gender

Comorbidities

Mood disorders and depression

Anxiety disorders

Tic disorder and Tourette's syndrome

Autistic and Asperger's disorder

Oppositional defiant disorder and conduct disorder

Substance abuse

Learning disabilities

CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS

Key findings

Diagnostic guidelines

Summary of DSM-IV criteria for the diagnosis of ADHD

Summary of ICD-10 criteria for the diagnosis of HKD

ADHD diagnostic algorithm

Diagnostic complications

Hyperkinesis versus attention deficit hyperactivity disorder

Gender

Age

Duration of symptoms

Diagnostic tools

ADHD Rating Scale

Copeland symptom checklist

Barkley's Current Symptoms Scale-Self Report Form (home and school)

Brown ADD Scale (diagnostic form)

Parent-completed Child Behavior Checklist

Teacher Report Form (TRF) of Child Behavior Checklist

ADD-H: Comprehensive Teacher Rating Scale (ACTeRS)

Frequency of diagnostic tool usage

Diagnosis rates

Time to diagnosis

Diagnostic unmet needs

Referral patterns

Direct consultations

Referral patterns of interviewed physicians

Types of medical professional referred to

Treatment planning

Treatment guidelines

AAP guidelines

The Texas Children's Medication Algorithm

UK NICE guidelines

Pharmacological treatments

Stimulants

Amphetamines

Adderall and Adderall XR

Dextroamphetamines

Dexedrine and Dexedrine SR/Spansule

Dextrostat

Methylphenidate

Ritalin

Focalin

Metadate

Methylin

Concerta

Cylert

Non-stimulants

Strattera

Drugs prescribed off label

Antidepressants

α2-agonists

Antipsychotics

Non-pharmacological therapy

Economic consequences

CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS

Key findings

Introduction

Prescribing trends

Pharmacological versus non-pharmacological therapy

First-line treatment strategies

Drug classes prescribed in first-line therapy

Drugs prescribed in first-line therapy

Children

Adolescents

Immediate- versus modified-release drugs

Country-specific first-line therapy

US

Japan

Progression to second-line therapy

Second-line treatment strategies

Drug classes prescribed in second-line therapy

Second-line add-on strategies

Immediate- versus modified-release drugs in add-on therapy

Drugs used in second-line add-on therapy

Second-line switch strategies

Immediate- versus modified-release drugs in switch therapy

Drugs used in second-line switch therapy

US

Japan

Europe

Factors influencing physician decision making

Drug attributes

Parent and patient influence

Product profiles

CHAPTER 7 IMPROVING TREATMENT OUTCOMES

Key findings

Unmet needs of ADHD

Longer-acting therapies

How to improve the perceived efficacy and uptake of longer-acting therapies

Zinc

Immediate- and modified-release combinations

Pharmacokinetics

Novel formulations

INSULIN PENS

BAND-AID

MULTIVITAMINS

METADATE CD

Advocacy initiatives

National ADHD Awareness Day

New product development

Methypatch (transdermal methylphenidate)

Focalin LA (dexmethylphenidate)

SPD-503

Provigil (modafinil)

ABT-089

NS-2359

Recently discontinued drugs

SPD473

CHAPTER 8 OPINION LEADER TRANSCRIPTS

KOL 1

KOL 2

APPENDIX A

Bibliography

Websites

APPENDIX B

Physician sample breakdown

Physician research methodology

Contributing experts

APPENDIX C

Physician questionnaire

Report methodology

Date of research completion

About Datamonitor

About Datamonitor Healthcare

Datamonitor Healthcare's research and analysis methodologies

Datamonitor Healthcare's therapy area capabilities

About the CNS analysis team

Datamonitor Healthcare's Consulting expertise

Datamonitor's Therapeutic Consulting expertise

Key therapy team members

Lynda Lynch, Director CNS

David Abramson, Therapeutic Lead Consultant

Disclaimer

List of Tables

Table 1: Patients diagnosed with ADHD across the seven major markets (2004 to 2010) (000s).

Table 2: Symptoms for ADHD/HKD in the DSM-IV and ICD-10

Table 3: Definition of ADHD in the DSM-IV

Table 4: Prevalence of ADHD across the seven major markets

Table 5: Prevalence of ADHD

Table 6: Proportion of males vs. females across the seven major markets

Table 7: Prevalence of comorbid disorders in ADHD (%)

Table 8: DSM-IV categorization of ADHD.

Table 9: ICD-10 categorization of hyperkinetic disorders

Table 10: Frequency of diagnostic tool usage (%)

Table 11: Diagnostic tools used by PCPs vs. Psychiatrists (%)

Table 12: Prevalence breakdown of ADHD across the seven major markets (2004)

Table 13: Professionals who make diagnoses of ADHD

Table 14: Proportion of patients referred to another physician type

Table 15: Proportion of patients referred to other medical professionals by PCPs

Table 16: Proportion of patients referred to other medical professionals by psychiatrists

Table 17: Stimulants approved for the treatment of ADHD

Table 18: Non-stimulants approved for the treatment of ADHD

Table 19: Drugs used off label for the treatment of ADHD

Table 20: Therapy types used in the treatment of ADHD

Table 21: Drugs used in first-line monotherapy in children across the seven major markets (%)

Table 22: Drugs used in first-line monotherapy in adolescents across the seven major markets (%)

Table 23: Immediate- vs. modified-release drugs prescribed in children at first-line across the seven major markets

Table 24: Immediate- vs. modified-release drugs prescribed in adolescents at first-line across the seven major markets

Table 25: Top three drugs prescribed for the treatment of ADHD in children across the seven major markets

Table 26: Top three drugs prescribed for the treatment of ADHD in adolescents across the seven major markets

Table 27: Add-on strategies in the second-line treatment of children with ADHD

Table 28: Add-on strategies in the second-line treatment of adolescents with ADHD

Table 29: Immediate- vs. modified-release drugs prescribed to children and adolescents in second-line add-on therapy across the seven major markets

Table 30: Second-line add-on therapy in children and adolescents

Table 31: Top three drugs prescribed for the treatment of ADHD in children and adolescents across the seven major markets

Table 32: Switching strategies in the second-line treatment of children with ADHD

Table 33: Switching strategies in the second-line treatment of adolescents with ADHD

Table 34: Immediate- vs. modified-release drugs prescribed to children at second-line switch therapy across the seven major markets

Table 35: Immediate- vs. modified-release drugs prescribed to adolescents at second-line switch therapy across the seven major markets

Table 36: Second-line switch therapy children

Table 37: Second-line switch therapy adolescents

Table 38: Top three drugs prescribed to children in second switch therapy across the seven major markets

Table 39: Top three drugs prescribed to adolescents in second switch therapy across the seven major markets

Table 40: Top three drugs characterized by physicians across the seven major markets

Table 41: ADHD pipeline products, 2004

Table 42: Price of Provigil and marketed once-daily ADHD drugs

Table 43: US physician sample breakdown, 2004

Table 44: Japan physician sample breakdown, 2004

Table 45: France physician sample breakdown, 2004

Table 46: Germany physician sample breakdown, 2004

Table 47: Italy physician sample breakdown, 2004

Table 48: Spain physician sample breakdown, 2004

Table 49: UK physician sample breakdown, 2004

List of Figures

Figure 1: Prevalence, diagnosis and drug treatment rates of ADHD across the seven major markets.

Figure 2: Prevalence and diagnosis rates of ADHD in the US

Figure 3: Drug treatment patterns in children with ADHD in the US

Figure 4: Drug treatment patterns in adolescents with ADHD in the US

Figure 5: Prevalence and diagnosis rates of ADHD in Japan

Figure 6: Drug treatment patterns in children with ADHD in Japan

Figure 7: Drug treatment patterns in adolescents with ADHD in Japan

Figure 8: Prevalence and diagnosis rates of ADHD in France

Figure 9: Drug treatment patterns in children with ADHD in France

Figure 10: Drug treatment patterns in adolescents with ADHD in France

Figure 11: Prevalence and diagnosis rates of ADHD in Germany

Figure 12: Drug treatment patterns in children with ADHD in Germany

Figure 13: Drug treatment patterns in adolescents with ADHD in Germany

Figure 14: Prevalence and diagnosis rates of ADHD in Italy

Figure 15: Drug treatment patterns in children with ADHD in Italy

Figure 16: Drug treatment patterns in adolescents with ADHD in Italy

Figure 17: Prevalence and diagnosis rates of ADHD in Spain

Figure 18: Drug treatment patterns in children with ADHD in Spain

Figure 19: Drug treatment patterns in adolescents with ADHD in Spain

Figure 20: Prevalence and diagnosis rates of ADHD in the UK

Figure 21: Drug treatment patterns in children with ADHD in the UK

Figure 22: Drug treatment patterns in adolescents with ADHD in the UK

Figure 23: Prevalence of ADHD across the seven major markets

Figure 24: Average age of onset of ADHD across the seven major markets

Figure 25: Proportion of patients progressing to adult ADHD

Figure 26: Prevalence of adult ADHD across the seven major markets

Figure 27: Proportion of males vs. females across the seven major markets

Figure 28: Prevalence of mood disorders across the seven major markets

Figure 29: Prevalence of anxiety disorders across the seven major markets

Figure 30: Prevalence of tic disorder and Tourette's syndrome across the seven major markets

Figure 31: Prevalence of autistic and Asperger's disorder across the seven major markets

Figure 32: Prevalence of oppositional defiant disorder and conduct disorder across the seven major markets

Figure 33: Prevalence of substance abuse disorders across the seven major markets

Figure 34: Prevalence of learning disabilities across the seven major markets

Figure 35: ADHD diagnostic algorithm, 2000

Figure 36: Diagnosis rate of ADHD across the seven major markets.

Figure 37: Length of time from initial presentation to diagnosis of ADHD

Figure 38: Key findings from the UK ADDIS ADHD study

Figure 39: A comparison of proportion of patients that consult either a PCP or psychiatrist directly or are referred

Figure 40: Referral rates to other medical professionals by PCPs and psychiatrists

Figure 41: AAP treatment algorithm (2001)

Figure 42: The Texas Children's Medication Algorithm

Figure 43: Therapy types used in the treatment of ADHD (child and adolescents)

Figure 44: Monotherapy vs. combination therapy as a first-line treatment of ADHD

Figure 45: Drug classes used in the first-line treatment of ADHD.

Figure 46: Proportion of patients progressing to second-line therapy.

Figure 47: Time from initiation of first-line therapy to progression to second-line therapy

Figure 48: Reasons patients discontinue methylphenidate usage

Figure 49: Second-line therapeutic strategies

Figure 50: Drug classes used at second-line for the treatment of ADHD

Figure 51: Key attributes most likely to influence drug choice

Figure 52: Physician rating of drugs approved for the treatment of ADHD

Figure 53: Child-orientated diabetes pen

Figure 54: Child friendly Band-Aids

Figure 55: Metadate CD marketing campaign

Figure 56: Physician awareness of pipeline drugs

Figure 57: Revenue of immediate-release and once-daily stimulants

Figure 58: Datamonitor's Healthcare Consultancy

Figure 59: Datamonitor Healthcare's Therapeutic Consulting capabilities