市場調査報告書：急性脳梗塞

Abstract

Overview

Introduction

Stroke is one of the top three leading causes of death worldwide and an area of high unmet needs. TPA is limited to a low number of ischemic stroke patients due to a short therapeutic time window, but it is still the best therapy available. TPA is responsible for major changes and advances in the way stroke patients are cared for, which is expected to evolve further.

Scope

Review of the available epidemiology data to assess the patient population of acute stroke.
Outline of the existing therapy options and the current prescribing trends.
Assessment of treatment outcomes and unmet needs associated with the outcomes.
Evaluation of the developmental agents in late stage clinical trials.

Report Highlights

The incidence of stroke has been slowly declining over the last 50 years, as well as mortality from stroke. However, stroke continues to be a major public health concern, being the third leading cause of death in the US after heart disease and cancer, and the leading neurologic cause of long-term disability.

The presently available tPA, while very efficacious, is to be used in acute ischemic stroke patients within the 3 hour time window since the onset of stroke symptoms. In order for more patients to be eligible for the treatment with the tPA, there should be more focus on significant infrastructure improvements in all of the major markets.

There has been a lack of progress in acute stroke drug development. Over the last 20 years huge efforts have been expended in developing neuroprotectants. Over 100 reached clinical evaluation but none has clearly demonstrated efficacy. The agents currently in late stage development do not offer much hope in replacing or contributing to tPA therapy.

Reasons to Purchase

target physicians more effectively, through an understanding of prescribing behavior and its influences.
validate new product forecasting based on diagnosis and treatment rates, and the likely rate of uptake for new products.
understand clinical trial requirements to prepare more effective NDAs.

ABOUT DATAMONITOR HEALTHCARE
- About the Cardiovascular pharmaceutical analysis team
CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Contributing experts
  - Experts interviewed for this report (interviewed in October 2007)
  - Experts interviewed for Stakeholder Insight 2005: Acute Stroke, DMHC2058 (interviewed in 2005)
  - Experts interviewed for Pipeline Insight 2005: Antithrombotics, DMHC2084 (interviewed in 2005)
  - Experts interviewed for Pipeline Insight 2006: Acute Stroke, DMHC2167 (interviewed in February 2006)
- Datamonitor insight into the stroke market
- Related reports
CHAPTER 2 INTRODUCTION AND SCOPE
- Coverage of the Stakeholder Insight survey
  - Country level "treatment trees"
  - Supporting data sets
CHAPTER 3 COUNTRY TREATMENT TREES
- Introduction to the treatment trees
  - United States
  - Japan
  - France
  - Germany
  - Italy
  - Spain
  - United Kingdom
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION
- Disease definition and classification
  - Symptoms
    - Ischemic stroke
    - Hemorrhagic stroke
    - Transient ischemic attack
- Epidemiology of stroke
  - Epidemiology methodology
    - US
    - Japan
    - Europe
- Key patient segmentations
  - Patient age
  - Comorbidities, complications and risk factors
CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS
- Presentation and diagnosis
  - Time to presentation
  - Diagnosis
    - Healthcare professionals involved in the diagnosis of stroke
    - Tests in emergency diagnosis of stroke
    - Secondary tests performed after initial diagnosis
- Influences on diagnosis and treatment rates
  - The National Stroke Association
  - STOP Stroke Act
  - The Stroke Association
- Treatment guidelines
  - Treatment of acute ischemic stroke
  - Treatment of hemorrhagic stroke
  - Stroke units
- Treatment pathways
CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS
- Ischemic stroke treatment
  - Antiplatelets
  - Anticoagulants
  - Thrombolytics
- Hemorrhagic stroke treatment
CHAPTER 7 IMPROVING TREATMENT OUTCOMES
- Treatment outcomes
  - Length of stay
  - Mortality
  - Recovery
    - Recurrence of stroke
- Unmet needs
  - Physician education: tackling physician competence and attitude
  - Patient education: raising stroke-symptom awareness
  - Infrastructural unmet needs: establishing, maintaining and expanding the network of dedicated stroke units.
  - Unmet clinical needs
    - Procoagulation
    - Neuroprotection
    - Revascularization
    - Safety
    - Efficacy
    - Extended time window of treatment
    - Ease of use
- New product development
  - Prolyse
    - Clinical trials
  - Ancrod
    - Clinical trials
  - Danaparoid sodium
    - Clinical trials
  - Dabigatran etexilate
    - Clinical trials
  - Clazosentan
    - Clinical trials
  - Rivaroxaban
    - Clinical trials
  - Desmoteplase
    - Clinical trials
  - Conclusion
APPENDIX A BIBLIOGRAPHY
- Epidemiology
- General and clinical trial data
APPENDIX B
- Physician research methodology
  - Physician sample breakdown
  - US
  - Japan
  - France
  - Germany
  - Italy
  - Spain
  - UK
APPENDIX C
- The survey questionnaire
  - 1. Patient Segmentation
  - 2. Presentation And Referral
  - 3. Diagnosis
  - 4. Treatment
    - Treatment of ischemic stroke
    - Treatment of hemorrhagic stroke
  - 5. Treatment Outcomes
- Glossary
DISCLAIMER
- List of Tables
  - Table 1: Incidence of first-ever stroke, 2007
  - Table 2: All stroke patients with comorbidities and risk factors in the seven major markets, 2007
  - Table 3: Causes of hemorrhagic stroke experienced by patients, 2007
  - Table 4: Type of medical professional diagnosing stroke, 2007
  - Table 5: Emergency diagnosis tests carried out in stroke patients, 2007
  - Table 6: Percentage of patients undergoing each test following initial diagnosis, 2007
  - Table 7: Antiplatelets given to ischemic stroke patients in the acute phase, 2007
  - Table 8: Antiplatelets given to ischemic stroke patients in the post-acute phase, 2007
  - Table 9: Anticoagulants given to ischemic stroke patients in the acute phase, 2007
  - Table 10: Anticoagulants given to ischemic stroke patients in the post-acute phase, 2007
  - Table 11: Types of therapy received by Ischemic stroke patients to prevent recurrence, 2007
  - Table 12: Late-stage drugs in development for stroke, 2007
  - US physician sample breakdown, 2007
  - Japan physician sample breakdown, 2007
  - France physician sample breakdown, 2007
  - Germany physician sample breakdown, 2007
  - Italy physician sample breakdown, 2007
  - Spain physician sample breakdown, 2007
  - UK physician sample breakdown, 2007
- List of Figures
  - Figure 1: Diagrammatic overview of the coverage of the Stakeholder Insight: Stroke survey, 2007
  - Figure 2: Summary of stroke treatment in the US, 2007
  - Figure 3: Ischemic stroke treatment in the US (I), 2007
  - Figure 4: Ischemic stroke treatment in the US (II), 2007
  - Figure 5: Ischemic stroke treatment in the US (III), 2007
  - Figure 6: Hemorrhagic stroke treatment in the US, 2007
  - Figure 7: Summary of stroke treatment in Japan, 2007
  - Figure 8: Ischemic stroke treatment in Japan (I), 2007
  - Figure 9: Ischemic stroke treatment in Japan (II), 2007
  - Figure 10: Ischemic stroke treatment in Japan (III), 2007
  - Figure 11: Hemorrhagic stroke treatment in Japan, 2007
  - Figure 12: Summary of stroke treatment in France, 2007
  - Figure 13: Ischemic stroke treatment in France (I), 2007
  - Figure 14: Ischemic stroke treatment in France (II), 2007
  - Figure 15: Ischemic stroke treatment in France (III), 2007
  - Figure 16: Hemorrhagic stroke treatment in France, 2007
  - Figure 17: Summary of stroke treatment in Germany, 2007
  - Figure 18: Ischemic stroke treatment in Germany (I), 2007
  - Figure 19: Ischemic stroke treatment in Germany (II), 2007
  - Figure 20: Ischemic stroke treatment in Germany (III), 2007
  - Figure 21: Hemorrhagic stroke treatment in Germany, 2007
  - Figure 22: Summary of stroke treatment in Italy, 2007
  - Figure 23: Ischemic stroke treatment in Italy (I), 2007
  - Figure 24: Ischemic stroke treatment in Italy (II), 2007
  - Figure 25: Ischemic stroke treatment in Italy (III), 2007
  - Figure 26: Hemorrhagic stroke treatment in Italy, 2007
  - Figure 27: Summary of stroke treatment in Spain, 2007
  - Figure 28: Ischemic stroke treatment in Spain (I), 2007
  - Figure 29: Ischemic stroke treatment in Spain (II), 2007
  - Figure 30: Ischemic stroke treatment in Spain (III), 2007
  - Figure 31: Hemorrhagic stroke treatment in Spain, 2007
  - Figure 32: Summary of stroke treatment in the UK, 2007
  - Figure 33: Ischemic stroke treatment in the UK (I), 2007
  - Figure 34: Ischemic stroke treatment in the UK (II), 2007
  - Figure 35: Ischemic stroke treatment in the UK (III), 2007
  - Figure 36: Hemorrhagic stroke treatment in the UK, 2007
  - Figure 37: Average age of stroke patients, 2007
  - Figure 38: Time to presentation after the onset of symptoms, 2007
  - Figure 39: Time taken to obtain emergency test results, 2007
  - Figure 40: Secondary diagnostic tests carried out in stroke patients, 2007
  - Figure 41: Overview of treatment guidelines for acute ischemic stroke
  - Figure 42: Overview of treatment guidelines for ICH
  - Figure 43: Organization of an acute neurological stroke unit
  - Figure 44: Share of respondents whose hospital has an acute stroke unit, seven major markets, 2007
  - Figure 45: Treatment Pathways, 2007
  - Figure 46: Percentage of patients that are referred from other hospitals or admitted as emergencies to stroke units, 2007
  - Figure 47: Percentage of ischemic stroke patients treated by each healthcare professional, 2007
  - Figure 48: Stroke patients receiving initial drug therapy in the ambulance or emergency room, 2007
  - Figure 49: Ischemic stroke patients treated with acute drug therapy, 2007
  - Figure 50: Ischemic stroke patients treated in the post-acute phase, 2007
  - Figure 51: Ischemic stroke patients receiving specified thrombolytic (%), 2007
  - Figure 52: Hemorrhagic stroke patients receiving each specified therapy, 2007
  - Figure 53: Hemorrhagic stroke patients undergoing surgery, 2007
  - Figure 54: Hemorrhagic stroke patients undergoing the specified surgical procedures, 2007
  - Figure 55: Average length of hospital stay, 2007
  - Figure 56: Stroke patients who die before receiving medical attention, 2007
  - Figure 57: Stroke patients who die in hospital, 2007
  - Figure 58: Level of recovery achieved by ischemic stroke patients, 2007
  - Figure 59: Hemorrhagic stroke patients making each type of recovery (%), 2007
  - Figure 60: Stroke patients referred for rehabilitation, 2007
  - Figure 61: Stroke patients that go on to have recurrent stroke (%), 2007

急性脳梗塞：TPAによるインフラの変化

Stakeholder Insight: Acute Stroke - TPA spurs infrastructure changes for the better

Abstract

Overview

Introduction

Scope

Report Highlights

Reasons to Purchase

Table of Contents