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Stakeholder Insight: Invasive Fungal Infections - Options Outweigh Replacements
Datamonitor, Jan 2004, Pages: 390
Chapter 1 EXECUTIVE SUMMARY 3
Scope of the analysis 3
Insight into the Invasive Fungal Infections market 4
The treatment of invasive fungal infections is changing from a specialty area, focused on specific subpopulations, to an increasingly high volume practice targeting large numbers of hospitalized and community based immunocompromised individuals. Datamonitor estimates that of 9 million global ‘at risk’ patients, 1.2 million will develop an infection; 5
Despite recent advances in treatment, mortality rates of invasive fungal infections remain unacceptably high. Fast, accurate diagnosis remains a key obstacle in the two most common pathogen groups, Candida and Aspergillus, especially the latter that is normally reliant on invasive measures. 7
There is enormous variability in patient risk factors, treatment response rates and a lack of consensus regarding outcome prevent clear recommendations as to the optimum type and duration of antifungal therapy. Despite this, Datamonitor research reveals a significant level of antifungal prophylaxis, approximately 23% of the total ‘at risk’ group, which appears varied across patient type and country, with differing success rates. 8
High efficacy, safety and convenience, and low cost of fluconazole (Diflucan) and itraconazole (Sporanox) allow these compounds to dominate antifungal prophylaxis and first-line curative therapy. Newer expensive agents, such as Vfend and Cancidas, have uncertain positioning, normally relegated to ‘back-up’ status after treatment failure or when toxicity restricts older generic agents. Unmet need in the treatment of invasive Aspergillus raises strong physician awareness of developmental compounds such as posaconazole (Schering-Plough). 10
Summary 13
Key metrics 14
Chapter 2 INTRODUCTION AND SCOPE 26
Coverage of the Stakeholder Insight Invasive Fungal Infections Survey 26
Methodology – points to note 28
Chapter 3 EPIDEMIOLOGY AND PATIENT SEGMENTATION 30
Invasive fungal infections definition and classification 30
Etiology of invasive fungal infections 31
Aspergillosis 32
Blastomycosis 33
Candidiasis 33
Coccidioidomycosis 34
Cryptococcosis 34
Histoplasmosis 34
Others 35
Epidemiology of invasive fungal infections 36
Co-morbidities, complications and risk factors 38
HIV/AIDS 39
Cancer patients 43
Transplant patients 46
Surgical patients 50
Neonates 54
Niche populations 57
Diabetics 57
Geriatric/elderly population 58
Burn victims 58
Key patient segmentations 60
Chapter 4 DIAGNOSIS AND TREATMENT OPTIONS 61
Curative therapy 62
Diagnosis 63
Treatment rates 65
Treatment lengths 67
Suppressive therapy 71
Prophylactic therapy 72
Treatment guidelines 77
Physician interaction 79
The role of the specialists 80
Pediatricians 83
Other hospital staff 83
Pharmacists – exerting more influence 84
Laboratory staff – microbiologists and pathologists 86
The surgeons – a special case 86
Treatment options 88
Product overview 89
Key product profiles 93
Diflucan 93
Sporanox 95
AmBisome 96
Abelcet 97
Cancidas 98
Vfend 100
Other antifungal agents 101
Summary 104
Chapter 5 PRESCRIPTION TRENDS AND PRODUCT USAGE 106
Factors influencing prescription decision 106
Prophylaxis prescription trends 109
Typical products used in prophylaxis 111
Success rates of prophylaxis 114
Product usage following prophylactic therapy failure 118
Curative therapy 119
First-line therapy 120
Second-line therapy 122
IV to oral switching 132
Other factors influencing product use 142
Resistance 142
Formulary inclusion 144
Chapter 6 IMPROVING TREATMENT OUTCOMES 145
Treatment outcomes 145
Mortality rates and complications 145
Invasive aspergillosis 146
Blastomycosis 148
Systemic candidiasis 148
Coccidioidomycosis 148
Cryptococcosis 149
Histoplasmosis 149
Rare mycoses 149
Breakthrough infections 150
Recurrence rates 150
Unmet needs 151
Combination therapy 154
Diagnostic unmet needs 156
New product development 159
Late-stage pipeline antifungal products overview 159
Posaconazole 160
Ravuconazole 160
Micafungin 160
Anidulafungin 160
Awareness of new antifungal products 161
US 161
Japan 162
EU 163
Perception 164
US 164
Japan 166
EU 167
Impact 168
Critical success factors 169
Chapter 7 OPINION LEADER TRANSCRIPTS 171
Key opinion leader 1 – Infectious disease physician 171
Section 1 - Epidemiology 171
Section 2 - Diagnostics 172
Section 3 – Treatment rates & prophylaxis 173
Section 4 – Treatment options 177
Section 5 - Prescription decisions 179
Section 6 – Treatment outcomes 180
Section 7 – Resistance issues 181
Section 8 – Unmet needs 181
Key opinion leader 2 – ICU physician 183
Section 1 – Epidemiology 183
Section 2 – Diagnostics 184
Section 3 – Treatment rates & prophylaxis 185
Section 4 – Treatment options 190
Section 5 – Prescription practices 191
Section 6 – Treatment outcomes 192
Section 7 – Resistance issues 193
Section 8 – Unmet needs 194
Key opinion leader 3 – Infectious disease pediatrician 196
Section 1 – Epidemiology 196
Section 2 – Diagnostics 199
Section 3 – Treatment rates & prophylaxis 201
Section 4 – Treatment options 206
Section 5 – Prescription practices 208
Section 6 – Treatment outcomes 210
Section 7 – Resistance issues 211
Section 8 – Unmet needs 212
Key opinion leader 4 – Infectious disease physician 214
Section 1 - Epidemiology 214
Section 2 - Diagnostics 215
Section 3 – Treatment rates & prophylaxis 216
Section 4 – Treatment options 220
Section 5 - Prescription decisions 222
Section 6 – Unmet needs 223
Key opinion leader 5 – Infectious disease physician 226
Section 1 - Epidemiology 226
Section 2 - Diagnostics 226
Section 3 – Treatment rates & prophylaxis 227
Section 4 – Treatment options 230
Section 5 - Prescription decisions 231
Section 6 – Treatment outcomes 233
Section 7 – Unmet needs 233
Key opinion leader 6 - Oncologist 235
Section 1 – Epidemiology 235
Section 2 – Diagnostics 236
Section 3 – Treatment rates & prophylaxis 236
Section 4 – Treatment options 240
Section 5 – Prescription practices 241
Section 6 – Treatment outcomes 243
Section 7 – Resistance issues 243
Section 8 – Unmet needs 244
Key opinion leader 7 – Infectious disease physician/pathologist 246
Section 1 - Epidemiology 246
Section 2 - Diagnostics 249
Section 3 – Treatment rates & prophylaxis 250
Section 4 – Treatment options 255
Section 5 - Prescription decisions 257
Section 6 – Unmet needs 259
Key opinion leader 8 – Infectious disease physician 261
Section 1 - Epidemiology 261
Section 2 - Diagnostics 262
Section 3 – Treatment rates & prophylaxis 263
Section 4 – Treatment options 268
Section 5 - Prescription decisions 268
Section 6 – Unmet needs 270
Key opinion leader 9 – Bone marrow transplant clinician 273
Section 1 – Epidemiology 273
Section 2 – Diagnostics 274
Section 3 – Treatment rates & prophylaxis 274
Section 4 – Treatment options 279
Section 5 - Prescription decisions. 280
Section 6 – Treatment outcomes 282
Section 7 – Resistance issues 283
Section 8 – Unmet needs 283
APPENDIX A ADDITIONAL DATA 286
APPENDIX B BIBLIOGRAPHY 309
Journal & news articles 309
Websites 318
Epidemiology sources 319
Key associations and conferences 319
APPENDIX C METHODOLOGY 321
Physician research methodology 321
Physician sample breakdown 321
US 321
Japan 321
France 322
Germany 322
Italy 323
Spain 323
UK 324
APPENDIX D QUESTIONNAIRES 325
The survey questionnaire 325
The opinion leader discussion guide 384
Section 1 - Epidemiology 384
Section 2 - Diagnostics 384
Section 3 – Treatment rates & prophylaxis 385
Section 4 – Treatment options 387
Section 5 - Prescription decisions 388
Section 6 – Treatment outcomes 388
Section 7 – Resistance issues 388
Section 8 – Unmet needs 389
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