Osteoarthritis: the silent burden
Osteoarthritis is the leading cause of disability in the US, and is estimated
to be the eighth most common cause of disability worldwide, with around 89
million adults in the seven major markets having a form of symptomatic
osteoarthritis. OA therefore offers an attractive commercial target. However,
relatively low disease awareness and Cox-2s controversy have curbed the
market's potential so far.
Osteoarthritis (OA) is a degeneration of the joints characterized by
progressive destruction of articular cartilage and articular structures. It is
a complex process that involves multiple changes in joint structure and,
according to Datamonitor estimates, affects 89 million adults in the seven
major pharmaceutical markets.
Due to the current widespread nature of the condition, the World Health
Organization (WHO) has declared the current decade (2000-2010) the 'Bone and
Joint Decade'.
Movement limited
High unmet need and a large patient population are the key drivers towards
research and innovation in osteoarthritis. The WHO estimates that 10% of men
and 18% of women over 60 years of age have symptomatic OA. It also estimates
that 80% of those with OA have limitations in movement and 25% cannot perform
the major daily activities of life.
Yet this debilitating and widespread condition has no cure and is most
commonly treated with simple analgesics and anti-inflammatories. General
awareness is low and, rightly or wrongly, many people consider this condition
to be simply a result of aging.
These ageist perceptions and low awareness have had a substantial negative
impact on the market. The fact that the oldest, least socially-visible section
of the population is most affected does go some way in explaining the
counter-intuitive differences between low general awareness and high
prevalence.
According to an EU key opinion leader interviewed by Datamonitor, "OA is a
silent burden, it's not a spectacular disease. In terms of awareness in the
population, I think it's going to change slowly with more people becoming
older and being affected, but I think awareness is not yet where it should
be."
Treatment requires paradigm shift
Treatment currently centers on palliative care including non steroidal
anti-inflammatory drugs (NSAIDs), but in the light of recent controversies
with Vioxx and Bextra in the Cox-2 class of pain killers, demand for
alternatives exists and a paradigm shift in the way osteoarthritis is treated
is needed.
Other effective treatment options are available - not least lifestyle factors
- but opioids and alternative therapies are also are battling against their
own preconceptions.
As OA patients suffer from an incurable and often inadequately-treated
condition, they tend to be particularly attracted to alternative medicine as a
means to reduce their pain. One of the reasons suggested for the success of
physiotherapy and certain acupuncture treatments is the beneficial impact of
sufficient time spent communicating with the patient, a luxury that many
physicians cannot afford.
The treatment of OA has historically been symptomatic, but increasing numbers
of drugs are being tested for a disease-modifying effect. The blockbuster
success of disease-modifying treatments for rheumatoid arthritis, such as the
TNF-inhibitors, and recent side-effect issues surrounding NSAIDs are the
driving forces behind this trend. However, evidence of successful disease
modification in OA is limited and the trials that have been conducted have not
shown particularly impressive results.
Clinical trials for disease modifying and symptomatic products for
osteoarthritis require careful design. However, the optimum design is not yet
decided among experts. Advances in imaging offer promise, but interpretation
of results must be unified and though the identification of biomarkers is
progressing, they are often difficult to utilize.
Challenges abound
Datamonitor has interviewed a range of OA professionals, including scientists
involved in laboratory research, patient advocates and opinion-leading
physicians. The range of views received agree on one key point: that OA
awareness is not as high as it should be.
This view was most strongly expressed by patient advocates, but is echoed in
comments regarding a lack of specific arthritis research funds in certain
countries, and a lack of musculoskeletal training for general practitioners.
Evaluating imaging and new lab tests to detect OA early, so that treatment can
begin before significant damage occurs is a key challenge faced by the
rheumatology community. Advances in magnetic resonance imaging (MRI) and
ultrasonography have begun to show internal details of articular cartilage
that correspond with histologic zones.
MRI technology should reduce the number of patients needed in clinical trials,
improve retention of these patients, and reduce the overall costs and the
length of clinical trials of treatment response to disease modifying OA drugs
(DMOADs). However, the cost of MRI can be a prohibitive factor in already
expensive clinical trials.
New treatments must focus on the impact of OA on patients, and physician
opinion indicates that a multi-disciplinary approach to OA treatment is
required; involving nurses, physiotherapists and other healthcare
professionals in the treatment. Factors such as the important effect of
fatigue on arthritis patients have been highlighted by such collaborations.
The issue of relative lack of awareness of OA must be addressed to make it a
higher priority for government research funding, which in turn aids the
development of treatments. OA offers a very attractive commercial target in
terms of patient potential, and the explosion in new disease modifying drugs
in rheumatoid arthritis has highlighted the possibilities for OA. However,
controversy in the Cox-2 class, preconceptions about alternative treatments
and even debate around the definition of OA make this a more difficult market
to break into than first thought.
Related research:
Stakeholder Opinions: Osteoarthritis - Preconceptions Damage Awareness and
Treatments priced $3,800
Commercial Insight: Disease Modification in Rheumatoid Arthritis - The
Biologics Boom priced $15,200
Event Analysis and Response Service: Cox-2s - Cox-2 Crisis Dents Big Pharma
Confidence priced $11,400
