REFERfil«,E CODE GDHC113PIOR I PUBLICATION DATE SEPTEMBER 2015
`
`Global Data>>
`Pharma Point
`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS
`TO 2024
`
`

`

`GlobalData>>
`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`Drug-treated population
`
`us
`5EU
`
`The table above presents the key metrics for
`
`(AR)
`rhinitis
`allergic
`the seven major
`in
`(7MM)
`pharmaceutical markets
`(US, France,
`Germany, Italy, Spain, UK, and Japan) during the
`forecast period from 2014-2024.
`
`$2.Bbn
`
`$2.5bn
`
`Allergic Rhinitis Market Will Grow to $7.3
`Billion by 2024
`
`Patanase patent expiry in 2014
`
`Astepro patent expiry in 2014
`
`Singulair patent expiry in Japan in 2016
`
`Veramyst generic entry in 2016
`
`HP-3060 drug launch in 2017
`
`S-555739 launch in the US and Japan in
`2017
`
`us
`5EU
`
`Japan
`
`Total
`Source: GlobalData
`SEU = FrMce, Germany, Haly, Spai~, and UK
`
`J.
`J,J.J.
`J.
`t
`t
`
`157,426,939
`
`36,430,171
`
`$2.74bn
`
`$2.57bn
`
`$1.96bn
`
`$7.27bn
`
`for AR
`sales
`the
`GlobalData estimated
`(prescription drugs only) in 2014, the base year of
`the forecast period, at approximately $7.20 billion
`across the seven markets covered in this report.
`The US contributed 38% of these sales, generating
`an estimated $2.8 billion. This was mainly due to
`the much higher prices of AR medications in the
`US, and
`the
`lack of over-the-counter (OTC)
`intranasal corticosteroids (INCS) for AR in this
`market in the base year.
`
`By the end of the forecast period in 2024, AR sales
`in the 7MM are forecast to remain stagnant to
`$7.27 billion at a Compound Annual Growth Rate
`(CAGR) of 0.1 % over the 10-year period. The
`second-generation H1 receptor antagonists and
`INCS are the leading drug classes in terms of
`market value. The INCS currently capture almost
`half the total AR market; however, their market
`
`allergen
`as
`34%
`to
`shrink
`share will
`treatment of
`for
`the
`immunotherapies
`(A!Ts)
`moderate-to-severe AR enter the market over the
`forecast period and start dominating this space,
`growing from 14% to 26% of the total AR sales.
`The uptake of these novel drugs will be a major
`driver of AR market growth, and will offset the dip
`
`Allergic Rhlmbs - Global Drug forecast and Market Analysis to 2024
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`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`in sales caused by Nasonex's
`
`(mometasone
`
`•
`
`Increasing pressure
`
`for cost-effectiveness
`
`furoate) 2014 patent expiry. The US market size
`
`across all markets, which will limit the pricing of
`
`will shrink slightly compared to the other markets
`
`new products, and in some cases, prevent
`
`-
`
`at a negative CAGR of 0.1 % -
`
`due to the
`
`their reimbursement.
`
`expected surge in generic and OTC competition in
`
`this market, driven by the first approvals of OTC
`
`INCS. In 2024, the US will retain its AR market
`
`The figure below illustrates the sales for AR in the
`
`US, 5EU, and Japan during the forecast period.
`
`share, representing 38% of the total market.
`
`Sales for AR by Region, 2014--2024
`
`The major drivers of the growth of the AR market
`
`over the forecast period include:
`
`• The introduction of several Aff tablets: Merck's
`
`Grastek (grass), Ragwitek
`
`(ragweed), and
`
`Mitizax (house dust mite [HOM]) tablets, as
`
`well as Greer's Oralair (grass) in the US.
`
`These
`
`new
`
`products
`
`overcome
`
`the
`
`inconvenience of conventional subcutaneous
`
`immunotherapies (SCITs).
`
`• The increasing global prevalence of AR.
`
`The major barriers to the growth of the AR market
`
`include:
`
`• Generic erosion of the leading brands for AR
`
`treatment,
`
`such
`
`as Nasonex, Astepro
`
`(azelastine hydrochloride}, and Singulair
`
`{montelukast sodium) in (Japan).
`
`• The
`
`increasing push
`
`for patients
`
`to self(cid:173)
`
`medicate using OTC drugs will decrease the
`
`prescription AR drug market size.
`
`2014
`Total:$7,181.3m
`
`2024
`Total:$7,265.3m
`
`•US
`
`■ France
`
`■ Germany
`
`11 Italy
`
`■ Spain
`
`•UK
`
`■ Japan
`
`13.5%
`
`source: GIOl:iSIData
`
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`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`the US. This is set to have a large impact on the
`prescription drug treatment rate, as patients are
`incentivized
`to self-diagnose and self-medicate
`
`using the growing number of OTC options. Direct(cid:173)
`increased co(cid:173)
`to-consumer (DTC) advertising,
`payments on prescription AR drugs, and stretched
`
`healthcare resources, as well as the increasingly
`competitive cost of OTC-equivalent options, will all
`further the progressively increasing trend for AR
`patients to seek treatment independently.
`
`large pharmaceutical
`the
`GlobalData expects
`companies with a previously strong foothold in the
`AR market, such as GSK, to be increasingly less
`
`focused on AR drugs. Instead, the major players
`are investing in research and development (R&D)
`for respiratory indications, but for asthma and
`chronic obstructive pulmonary disease (COPD),
`
`rather than for AR.
`
`Executive Summary
`
`Companies are Diverting Their AR Portfolios to
`
`the OTC Market
`
`Historically, the AR market has been very large,
`with several companies
`launching drugs
`that
`gained blockbuster status. In particular, Merck &
`
`Co. has had a very strong presence, leading the
`AR market with its three franchises, Nasonex,
`Singulair, and Clarinex
`(desloratadine). Other
`players
`defining
`the AR market
`include
`GlaxoSmithKline
`(GSK), Sanofi, and Teva.
`However, over the past decade, almost all the key
`drugs for the treatment of AR symptoms have lost
`patent protection,
`including Sanofi's Allegra
`(fexofenadine hydrochloride), Pfizer/UCB Pharma's
`Zyrtec (cetirizine hydrochloride) and two of Merck's
`
`blockbuster drugs, Singulair and Nasonex. As a
`result, AR, which was once a blockbuster-status
`
`is now highly saturated and
`therapy area,
`genericized, with companies seeing large declines
`in the sales of their respiratory portfolios due to
`generic erosion.
`
`In an attempt to retain a revenue stream from
`branded generics, companies have sought a
`
`successful strategy to convert their AR prescription
`drugs to OTC status, known as the Rx-to-OTC
`switch,
`transferring
`these products
`to
`their
`respective consumer care units. The most recent
`examples of
`this are
`the Food and Drug
`Administration's (FDA's} approval of OTC status
`for Sanofi's Nasacort Allergy 24HR (triamcinolone
`intranasal) and GSK's Flonase
`(f!uticasone
`propionate), the first INCS to be available OTC in
`
`Allergic Rhiriltls - Global Drug Forecast and Marl<et Analysis to 2024
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`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`The figure below provides an analysis of the
`
`Japanese pollen counts have grown five fold over
`
`company portfolio gap in AR during the forecast
`period.
`
`Company Portfolio Gap Analysis in AR, 2014-2024
`
`flEDA
`
`f l lt V\O lff
`
`1,.\1
`
`,r::11111
`
`.._
`~
`SANOFI
`
`the past three decades. A primary cause of the
`rising pollen levels is the afforestation policy of
`cedar, cypress, and birch
`trees, which was
`introduced during the post-World War 11 era (1949-
`1954) to provide a steady supply of domestic
`lumber. Today, there are an estimated 4.5 billion
`cedar trees in Japan. In addition to the increasingly
`
`prevalent Japanese tree pollen, Asian dust events
`occur, where smog laden with fine particles less
`in diameter, known as
`than 2.5 micrometers
`PM2.5, enters Japan through from inland China -
`for example, from the Gobi Desert, where the
`
`yellow dust picks up dirt and pollen and carries it to
`South Korea and Japan via the westerly winds.
`Increasing pollution from this region is contributing
`
`Strength of P, eline
`
`to the AR problem in Japan.
`
`Source: GtobalData
`
`There is a Growing Prevalence of AR Patients
`
`increasingly prevalent
`is becoming an
`AR
`condition, with
`the most common form be1ng
`moderate to severe in nature (Baena-Cagnani et
`al., 2015). According to the European Academy of
`Allergy and Clinical Immunology (EAACI), 50% of
`Europeans will suffer from an allergy by 2027
`(Papadopoulos et al., 2012}. A GlobalData
`epidemiological study estimated that about one in
`seven people in the US have been diagnosed with
`AR at some point in their life, or about 43 million
`people. This rate appears to be on the rise, and is
`expected to reach over 46 million by 2024.
`
`Furthermore, studies have shown that pollen levels
`are rising in tandem with global warming. Global
`climate change is evidenced by the increasing
`average
`earth
`temperature,
`increasing
`anthropogenic (caused by humans) greenhouse
`gas levels, and elevated pollen levels. Pollutants of
`interest include carbon dioxide (CO2}, ozone (03),
`they can
`and nitrous oxide (N02), because
`enhance
`the allergic
`response and
`lead
`to
`
`respiratory
`symptoms of allergic
`increased
`diseases. Heightened CO2 levels stimulate pollen
`
`increased
`production via photosynthesis and
`growth in multiple investigated plant species (Lin
`and Zacharek, 2012). Allergen patterns are also
`changing in response to climate change, and air
`
`Allergic Rhin1hs - c;;lobal Drug for~st an,d Market Analysis to 2024
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`GlobalData>>
`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`pollution can modify the allergenic potential of
`pollens,
`especially
`under
`specific weather
`
`antihistamines (AHs), INCS, and oral leukotriene
`receptor antagonists (LRAs), which are also known
`
`conditions. The prevalence of asthma and allergic
`diseases has increased dramatically during the
`past few decades {D'Amato et al., 2013). This
`
`is supported by
`notion
`the
`in
`the change
`prevalence of AR in the US population, from 10%
`in 1970 to 30% in 2000, It has been postulated that
`the changing environment, particularly the trend of
`global warming, may lead to increased pollen
`exposure and expanded environments for the
`growth of numerous plant species. An increase in
`the growing season, with earlier flowering and
`possibly increased airborne pollen counts, could be
`the consequences of the projected rise in the
`earth's temperature.
`
`Pollen seasons are set to last longer and to
`
`If pollen
`intense.
`increasingly more
`become
`seasons are going to overlap more frequently, the
`severity
`of
`symptoms
`experienced
`by
`polysensitized patients is set to increase. This
`increase in the AR prevalence will be a strong
`driver of the growth of this market, as the AR
`patient pool will
`increase,
`leading
`to higher
`consumption of medications used to treat the
`disease.
`
`There is a Large Unmet Need for the Treatment
`
`of Severe, Persistent AR That is Refractory to
`the Standard Therapies
`
`AR symptoms can be controlled in the majority of
`patients using
`the current standard
`therapies,
`which are based mainly on combinations of
`
`as leukotriene inhibitors and antileukotrienes. INCS
`and AHs are the gold-standard, first-line therapies
`receiving
`for AR patients. However, despite
`maximum doses of evidence-based therapy as
`
`directed by the ARIA (Allergic Rhinitis and its
`Impact on Asthma) guidelines, a significant
`percentage (approximately 20%) of patients with
`AR, particularly moderate to severe AR, have
`inadequately controlled symptoms (Bousquet et al.,
`2010). Refractory patients are often diagnosed with
`severe chronic upper airway disease (SCUAD),
`
`and represent a therapeutic challenge clinically.
`Furthermore, AR is often undiagnosed; in Europe,
`as many as 25-60% of patients with AR are not
`diagnosed
`(Bauchau
`and Durham,
`2004).
`
`Therefore, there are considerably high unmet
`needs within the indication, which are both clinical
`and environmental in nature. Overall, these needs
`mainly reflect the primary care culture, which often
`
`dismisses AR as a minor condition, despite the
`huge
`socioeconomic
`and morbidity
`costs
`associated with the disease. This leads to poor
`diagnosis, lack of patient compliance with the
`standard
`therapies, and
`inadequate symptom(cid:173)
`related treatment.
`
`The level of environmental unmet need in AR is
`high. Patients and primary care physicians (PCPs)
`alike have a low awareness of the impact of AR.
`This directly impacts the drug treatment rate, with
`taking any
`therapy.
`many AR patients not
`
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`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`Physicians also often show an underappreciation
`for the prevalence of mixed rhinitis, which consists
`of a combination of allergic and non-allergic rhinitis
`
`(NAR}, and the challenges involved in its diagnosis
`and treatment. Multiple patient-derived factors,
`combined with
`inadequate
`treatment options,
`
`means that the majority of AR patients continue to
`experience symptoms, even though they have
`received
`treatment directed by
`the ARIA
`guidelines. Patients are often highly dissatisfied
`with their treatment options, are non-compliant,
`and often alternate their prescription medications
`with OTC products due to a lack of adequate
`efficacy or a perceived reduction in efficacy over
`time. Patients often try several medications, with
`approximately 75% of patients taking more than
`one symptomatic therapy simultaneously in search
`of a medication that actually "works" (Demoly et al. ,
`
`2002).
`
`Novel Symptomatic Products Will Struggle to
`
`Enter This Large Genericized Market
`
`The AR treatment paradigm is well-defined, and
`the AR market is mature and highly genericized,
`
`with numerous drug classes that target a number
`of nasal symptoms associated with AR Following
`the high-profile patent expiries of several
`blockbuster drugs marketed by
`the
`leading
`manufacturers in this area, a wealth of inexpensive
`
`generic options became available, both by
`prescription and OTC. As the market is very
`saturated, the average daily cost of therapy is
`exceedingly low for all the drug classes.
`
`There is little room for new entrants, as the market
`is well-served by a wealth of symptomatic
`
`therapies. Since the competition is increasing, the
`market for AR therapies is becoming increasingly
`less
`lucrative. Also,
`there are currently no
`breakthrough symptomatic
`therapy products
`in
`clinical development. The remaining clinical unmet
`needs in this market include the requirement for
`more efficacious products, and the underserved
`area
`of
`causative
`therapies,
`such
`as
`immunotherapies, which
`target
`the underlying
`cause of the disease.
`
`Clinical trials evaluating novel AR treatments are
`
`complicated by several factors, including variable
`allergy
`testing methods, fluctuations
`in pollen
`counts, and the timing and intensity of additional
`seasonal allergens. This is further complicated
`
`immunotherapies, as
`assessing
`when
`the
`treatment must be initiated prior to the onset of the
`following pollen season. Therefore, subjects are
`enrolled into trials based on their symptoms during
`the previous pollen season, which may vary over
`consecutive years and pollen seasons. Variable
`weather patterns, and hence fluctuating pollen
`counts, have thwarted the efforts of several drug
`manufacturers that are developing new treatments
`for AR.
`
`Environmental exposure chambers (EECs) create
`stable and reproducible allergen exposure under
`highly standardized environmental conditions, and
`have been used to assess several AR drugs,
`including AHs such as Allegra and Claritin
`
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`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`(loratadine). However,
`
`this method has been
`
`and Stallergenes will lead the way by introducing
`
`criticized, as it doesn't reflect the "real-world"
`
`their relevant allergens in tablet form into the
`
`experience of patients with AR. Further validation
`
`Japanese and US markets
`
`through
`
`licensing
`
`of this study method will be required before it gains
`
`acceptance by the European Medicines Agency
`(EMA) and the FDA as a sufficient method to
`
`assess AR drug efficacy and safety.
`
`The challenges involved in evaluating novel AT
`
`pipeline agents using the current gold-standard
`
`clinical practices wilt affect the launch of new AR
`
`drugs, which could ultimately discourage drug
`
`the development of
`from pursuing
`companies
`pipeline candidates in this space.
`
`Market
`The
`lmmunotherapies
`Landscape
`for
`Population
`
`of
`Entry
`Approved
`Will Improve the Treatment
`the Difficult-to-Treat AR
`
`One of the few remaining unmet needs in the AR
`
`market is for a causative therapy that is capable of
`providing
`long-term
`relief of symptoms. The
`
`allergen-specific immunotherapy (SIT) market is
`
`the clinical development of a new generation of
`tablet formulations, moving away from the standard
`SCIT injections and sublingual
`immunotherapy
`
`(SLIT) drops. Tablet formulations that have been
`
`evaluated according to a standardized stepwise
`
`algorithm in dose-finding studies and double-blind,
`placebo-controlled efficacy
`trials have gained
`
`marketing authorization (MA) via the traditional
`
`routes. These products will continue
`
`to add
`
`legitimacy
`
`to
`
`immunotherapy as an
`
`important
`
`treatment option for patients with AR ALK-Abello
`
`partners. Japan, a market previously not widely
`treated with SIT, is set to see a new range of
`
`standardized,
`
`clinically-evaluated
`
`products
`
`containing the two most prevalent allergens: HDM
`and Japanese cedar pollen. These
`treatment
`
`options will include AIT formulations that were
`
`previously
`
`unavailable
`
`in
`
`the
`
`market.
`
`Advancements in SIT, particularly the advent of
`tablet
`formulations, will
`increase
`the use of
`
`immunotherapy among the pediatric population.
`
`The introduction of AITs will drive growth in the AR
`
`market, due to their high cost relative to the
`
`standard subcutaneous (SC) allergen extracts,
`
`thereby decreasing the negative impact of the
`
`growing genericized market.
`
`What Do Physicians Think?
`
`The key opinion leaders (KOLs) interviewed by
`
`GlobalData for this report highlighted the need for
`
`an increase in awareness of the evidence-based
`
`AR
`
`treatment guidelines among healthcare
`
`professionals, pharmacists, and patients, which
`
`would ideally lead to an increase in the number of
`
`patients with adequate symptomatic control. The
`
`current standard medications. such as AH and
`
`INCS therapies, tackle only the symptoms; KOls
`said they do not expect that novel drugs in these
`
`classes will fulfill this need. The immunotherapies
`
`in development will address these issues to some
`
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`ALLERGIC RHINITIS -
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`
`Executive Summary
`
`degree, but only in a very small proportion of AR
`
`sufferers, and they will be very costly.
`
`"There are quite a fat unmet needs [in AR]. First of
`
`af/, if you look at - actuaf/y, the quality of life of
`there's stiff a debate. In reality,
`these patients -
`optimal quality of life is reached by no more than
`one third of [AR] patients. No more than one third
`of our patients. This means that two third[s] -
`they
`don't have the optimal quality of life. There is still
`room for improvement. And they recently did a
`suNey of many societies, and in reality,
`the
`patients, independently of the prescription of the
`GP {general practitioner] or whatever,
`the vast
`
`majority are using two or three different treatments
`[at the same time] for the allergic rhinitis. This
`means that there is a lot to investigate, and a lot of
`{roam far] improvement for treatment."
`
`EU Key Opinion Leader
`
`"One of the ways in which we can help patients
`with rhinitis is to promulgate the guidelines. We're
`just re-doing the evidence-based guidelines. I think
`the promulgation - getting them down to patients,
`to GPs, {and} to practice nurses in a way that they
`can use them will be ve,y helpful to patients."
`
`EU Key Opinion Leader
`
`"I think [the US-based practice parameters, and
`also
`the
`ARIA
`guidelines]
`are
`pretty
`comprehensive, and I think
`they are
`largely,
`heavily evidence-based, which makes it ve,y useful
`for me. I [have] found them [to be] ve,y good; I
`think they are useful. I don't think they are widely
`
`distributed. But personally, when I teach about
`affergic rhinitis or research, or give patient care, I
`refer to them and use them. "
`
`US Key Opinion Leader
`
`the prima,y care
`the United States,
`"In
`doctors ... see many, many patients in a day. They
`
`have ve,y little time to get educated on [the]
`guidelines for [the] multitudes of diseases that they
`manage. And for a disease like allergic rhinitis, the
`chances are [that] they are not up on
`[the]
`guidelines or the guideline-driven care for it, so
`they do a bad job at
`overall, in my opinion,
`[managing] it."
`
`US Key Opinion Leader
`
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`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`"Well, [in] the [AR] patient population, in general,
`there's a very significant [percentage} - perhaps
`
`40% of patients seen will have mixed rhinitis. That
`is, they wJ11 have positive allergy skin tests, some
`of which are clinically significant, but the pathology
`underlying their disease is not limited to allergy.
`Although we classify them as having allergic
`rhinitis, they're really mixed. So, {this means] that
`they'll have underlying triggers which are irritants-,
`such as cigarette smoke, paint fumes,
`[and]
`weather conditions, as welf. These are
`the
`{treatment-] resistant population; it's not the purely
`
`seasonal allergic rhinitis. A person who comes into
`this office with tree and grass poflen allergy limited
`to the springtime is really a piece of cake. They're
`very easy to treat. They respond almost universally
`to therapy, and they're not resistant. [However,) it's
`a patient who comes into the office that has
`positive skin tests, and they also have seasonal
`they have an underlying
`allergic rhinitis, but
`pathology related to non-allergic triggers as well;
`they're the resistant ones."
`
`US Key Opinion Leader
`
`"Of course, it is easier to spend money on
`antihistamines and nasal steroids. But the problem
`is {that] in the future, if {the number of] this kind of
`patient with severe allergic rhinitis increases, it is
`possible that this kind of treatment is not sufficient
`and cannot satisfy the patient. For this reason,
`immunotherapy and the use of immunotherapy
`can. in a way, increase."
`
`EU Key Opinion Leader
`
`"We know that about over half the patients with
`nasal aflergies never go see a physician; [instead,]
`they treat it {using products sold] over the counter.·
`
`US Key Opinion Leader
`
`the {AR patient) flow is. they
`As I mentioned,
`usually go first to pharmacists, the second step is
`the GP, and the third step is the specialist. Usualfy,
`when they come [to the specialist], [it's because]
`there's a special reasons [sic], or [it's] because
`they have already got the disease. And, of course,
`[it's] because with the usual treatments, they don1
`the sufficient benefit, or because
`they
`get
`
`immunotherapy,
`to have
`specificaf/y want
`instance, and this is the {turning) point for them.
`
`for
`
`EU Key Opinion Leader
`
`Allergic Rhiriltls - Global Drug Forecast and Marl<et Analysis to 2024
`@'GlobalData This report 1s a licensee product and is not to be cop,eq, rep1oouce<1. shared or resold in any form
`
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`GlobalData>>
`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Executive Summary
`
`"Clearly,
`
`if family doctors cured [AR} patients
`
`enough, [aflergy} specialists woufd not exist. [Yet]
`we exist still. This fact suggests they're [family
`doctors] incompetent when prescribing [allergy]
`treatments, [and] are not following any guidelines. ·
`
`Japanese Key Opinion Leader
`
`Allergic Rhiriltls - Global Drug Forecast and Marl<et Analysis to 2024
`@'GlobalData This report 1s a licensee product and is not to be cop,eq, rep1oouce<1. shared or resold in any form
`
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`
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`
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`

`GlobalData>>
`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Table of Contents
`
`1
`
`Table of Contents
`
`1.1
`
`List of Tables .. ........... ............................. .. .................................................................. ...... 19
`
`1.2
`
`List of Figures ................................................................................................................... 22
`
`2.1
`
`2.2
`
`2.3
`
`3.1
`
`3.2
`
`3.3
`
`Catalyst. ............................................................................................................................ 23
`
`Related Reports ................................................................................................................ 24
`
`Upcoming Related Reports ..... ............ .... .. ................... ........... .......................................... 24
`
`Etiology and Pathophysiology ................. .. ....................... ................................. ................ 25
`
`Symptoms ......................................................................................................................... 28
`
`Classification ..................................................................................................................... 29
`
`3.3.1
`
`Seasonal and Perennial AR .................................... .. ......... .......................... .......... ... .. .. 29
`
`3.3.2 ARIA Classification of AR .............................................................................................. 29
`
`3.4
`
`Diagnosis .......................................................................................................................... 30
`
`3.5
`
`Quality of Life .................................................................................................................... 32
`
`ff;t~~'i:.t't~,,;
`
`;~jiiif:~ii/~;j~?:I;ijiiiitii~:ii~i.t~i~;:;i0~g;i;t,~
`
`4.1
`
`Disease Background ......................................................................................................... 33
`
`4.2
`
`Risk Factors and Comorbidities ................ ........................................................................ 34
`
`4.2.1
`
`A family history of AR is a strong predictor for AR in children and adults ....................... 35
`
`4.2.2 Exposure to allergens in the environment increases the risk for AR .............................. 36
`
`4.2.3 Urban living elevates the risk for AR. ............................................................................. 36
`
`Allergic Rhiriltls - Global Drug Forecast and Marl<et Analysis to 2024
`@'GlobalData Tb1s report 1s a licensee product and ,snot to be cop,eq. rep1oouce<1. shared or resold in any form
`
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`GlobalData>>
`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Table of Contents
`
`4.2.4 Co morbidities .... ...................... ....... ........ ..... ..... ........ ............ .. .... ... .. ..... ....... .. ..... .... ....... 37
`
`4.3
`
`4.3.1
`
`Global and Historical Trends .. ......... .... .. .. .. ..... ........ .. .. .. ........... ...... ..... ........ .... .. ................. 39
`us ................................................................................................................................. 39
`
`4.3.2
`
`5EU ........... ....................................................... ...... .............................. ................ ......... 40
`
`4.3.3
`
`Japan .... .... ... ... .. ... ... ... .. ........ ... .. ..... ..... .... ......... .... ... ... .... ... .... .... ... ........ ........ ... ...... ..... ... 41
`
`4.4
`
`Forecast Methodology ..... ... ...... .......... ....... ................. ............ ................. ... ......... ........ ... ... 42
`
`4.4.1
`
`Sources Used ... ..... .. ............ ..... ....... .... .. ......... ......... ...... ...... ..... ...... ............. ..... ........ ... .. 44
`
`4.4.2 Sources Not Used ........ .. .... ..... ......... ................ ..... ..... .. ................... ........... ..... .. ........... . 47
`
`4.4.3
`
`Forecast Assumptions and Methods ..... ....... .. .... .. .... .... .... .... ..... ..... ... ........ .. ... .... ... ... .. .. .47
`
`4.5
`
`Epidemiological Forecast for AR (2013-2023) ........................................... ..... ......... .... ..... 50
`
`4.5.1
`
`Total Prevalent Cases of AR ............ ...................... ........................................... ..... ..... .. 50
`
`4.5.2 Age-Specific Total Prevalent Cases of AR .................................................................... 52
`
`4.5.3 Sex-Specific Total Prevalent Cases of AR. ...................... .... .. ............................. ..... ..... . 54
`
`4.5.4 Age-Standardized Total Prevalence of AR .. .. ..... ...... ..... .. .... ........... .. ..... ..... ...... .. ...... .... . 56
`
`4.5.5 Distribution of Total Prevalent Cases of AR by Severity .. ....... .......... ................. .. .......... 58
`
`4.5.6 Distribution of Total Prevalent Cases of AR by Type ............ .... ........ ...... ...... ............ .... . 59
`
`4 .5. 7 Distribution of Total Prevalent Cases of AR Sensitized to Specific Allergens .. ... .. ...... .... 60
`
`4.6
`
`Discussion .......... .... ........ ........... ................. ...... ............ .. ... ..... .......................................... 61
`
`4.6.1
`
`Epidemiological Forecast lnsight... .. .................. ..... ....................................................... 61
`
`4.6.2
`
`Limitations of the Analysis .. ...... ..................................................................................... 61
`
`4.6.3 Strengths of the Analysis .. .... ... .. ... ...... .. ... ....... ... .... ........ .... ..... ... ... ... ...... .... .. .... ........ ... ... 62
`
`5.1
`
`Diagnosis and Treatment Overview .... ........ ........... .... ........ ...... ..... ..... .. ..... ....... ..... .. ..... .... . 63
`
`Allergic Rhiriltls - Global Drug Forecast and Marl<et Analysis to 2024
`@'GlobalData This report 1s a licensee product and is not to be cop,eq. rep1oouce<1. shared or resold in any form
`
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`GlobalData>>
`
`ALLERGIC RHINITIS -
`GLOBAL DRUG FORECAST AND MARKET ANALYSIS TO 2024
`
`Table of Contents
`
`5.1.1
`
`Diagnosis ...................................................................................................................... 63
`
`5.1.2
`
`Treatment Guidelines and Leading Prescribed Drugs ................................................... 64
`
`5.1.3 Clinical Practice ............................................................................................................. 67
`
`5.2
`
`US ................................................................................... .................................................. 76
`
`5.3
`
`5.4
`
`France ... ... .... ... ... .. ... ... .... ..... .... ... .. .......... .... ........ ...... .... ... .. ... ......... .......... ..... ..... ..... .. ...... .. 79
`
`Germany .................................................................................. ................ ......................... 81
`
`5.5
`
`Italy ... .................................... .. ..................... ............. .. ...................... ......... ., ..................... 85
`
`5.6
`
`Spain ..........................................................................................