Management of Urinary Incontinence and Overactive Bladder

Summary

Introduction

Although there are many marketed treatments for overactive bladder, there are few available for stress urinary incontinence or interstitial cystitis. Furthermore, despite available treatments for overactive bladder, many are associated with side effects leading to poor treatment compliance. With significant unmet needs remaining in these markets, there are clear opportunities for new entrants.

Highlights

Drug therapy for urinary disorders has predominantly focused on the overactive bladder market - particularly urge urinary incontinence (UUI). However, as the UUI market becomes increasingly crowded, product differentiation is key. By focusing on the urgency and frequency symptoms, companies may be able to tap into an under-served market niche.Stress urinary incontinence (SUI) is considered the most common subtype of urinary incontinence, but poor awareness and limited treatment options have impacted presentation, diagnosis and treatment rates. The recent approval of duloxetine in the EU presents physicians with a much-needed treatment alternative, but uptake has been slow.Poor understanding of the underlying causes of interstitial cystitis (IC) have made diagnosis, management and development of effective drugs for this disorder difficult. With many physicians resorting to treatments that are not specifically approved for IC, experts in the field believe that this could be leading to suboptimal treatment outcomes.

Scope

• Overview of epidemiology, presentation and referral patterns, and diagnostic assessment for UUI, SUI, MUI, dry OAB, and ICh3>
• Role and use of non-pharmacological versus pharmacological treatment for UUI, SUI, MUI, dry OAB, and ICh3>
• Influences on treatment choice and perception of current drug therapies including tolterodine, oxybutynin, darifenacin, solifenacin and duloxetine
• Evaluation of unmet needs and future outlook including awareness of the R&D drug pipeline

Reasons to Purchase

• Forecast product sales by understanding key aspects of epidemiology, diagnosis and treatment
• Gain a better understanding of the challenges facing current and future players in the overactive bladder and urinary incontinence market
• Identify physicians' key concerns including unmet needs and the attributes that physicians believe are desirable for future treatments

Contents

• Chapter 1 Executive Summary
  • Scope of the analysis
  • Objective of the analysis
  • Datamonitor insight into the urinary incontinence and overactive bladder market
  • Drug therapy for urinary disorders has predominantly focused on the overactive bladder market-particularly urge urinary incontinence (UUI). However, as the UUI market becomes increasingly crowded, pharmaceutical companies must able to demonstrate to physicians that there is a clear difference between their newer products and the more established products on the market. By focusing on the urgency and frequency symptoms, companies may be able to tap into an under-served market niche.
  • Stress urinary incontinence is considered the most common subtype of urinary incontinence. Nevertheless, poor awareness and limited treatment options for this condition have impacted presentation, diagnosis and treatment rates. The recent approval of duloxetine in the EU presents physicians with a much-needed treatment alternative, but uptake has been slow.
  • Interstitial cystitis (IC) is considered a rare disorder and poor understanding of its underlying causes have made diagnosis, management, and development of effective drugs for the disorder difficult. At present there are few effective treatments for IC and as a result, many physicians prescribe a wide variety of treatments that are not specifically approved for IC but may treat one or more of the symptoms. However, experts in the field believe that this could be leading to suboptimal treatment outcomes, and highlight the need for research into this area.
• Chapter 2 Oab And Ui Treatment Trees
  • UUI
  • Dry OAB
  • SUI
  • MUI
  • IC
• Chapter 3 Introduction
  • Normal bladder function
  • Definition of urinary incontinence and overactive bladder
  • Urinary Incontinence
  • Overactive bladder-wet versus dry
  • Interstitial cystitis
  • Etiology
  • Overactive bladder-wet and dry
  • SUI
  • MUI
  • Interstitial cystitis
• Chapter 4 Epidemiology
  • Stress urinary incontinence is the most common form of UI
  • The prevalence of OAB/UI varies according to study
  • US
  • EU
  • Japan
  • Other markets
  • Prevalence of OAB/UI usually rises with increasing age
  • Interstitial cystitis is rare
• Chapter 5 Presentation And Diagnosis
  • Presentation
  • Less than half of patients seek treatment for UI/OAB
  • A variety of reasons for patients failing to seek help for OAB/UI
  • Bothersome symptoms or symptoms affecting quality of life have the greatest impact on a patient's decision to see a healthcare professional
  • Diagnosis
  • Physicians may underestimate the severity of condition
  • Physicians use different measures to assess severity of condition
  • Pharmaceutical companies can help improve presentation and diagnosis
  • Improve general public/patient awareness and aim to reduce stigma
  • Improve awareness and facilitate diagnosis/prescribing among front-line healthcare providers
• Chapter 6 Referral Pattern
  • PCPs are typically the first healthcare professionals with whom patients will have discussed their symptoms
  • Referrals from PCPs to specialists increase with the severity of the condition
• Chapter 7 Current Treatment
  • OAB (UUI and dry OAB)
  • Pharmacological versus non-pharmacological therapy
  • UUI treatment
  • The majority of patients with UUI receive a pharmacological therapy
  • Decreasing the number of incontinence episodes is the key goal when treating a patient with UUI
  • Pharmacological interventions are introduced when UUI is affecting day-to-day activities
  • Tolterodine is the most popular first- and second-line drug treatment for UUI
  • Dry OAB treatment
  • Fewer patients with dry OAB receive pharmacotherapy than patients with UUI
  • Improving quality of life is the key goal when treating a patient with dry OAB
  • Pharmacological interventions are introduced when dry OAB is affecting day-to-day activities
  • Physicians' treatment choice for dry OAB is typically the same as for UUI
  • Stress urinary incontinence
  • Pharmacological versus non-pharmacological therapy in SUI
  • Non-pharmacological therapies are the most popular treatment choice for SUI
  • Decreasing the number of incontinence episodes occurring upon exertion is the key goal when treating a patient with SUI
  • Pelvic-floor exercises are the most popular non-pharmacological therapy choice
  • Surgery is seen as the definitive treatment option for SUI but is not appropriate for all patients
  • Pharmacological interventions are introduced when SUI has any effect, or a significant effect, on day-to-day activities.
  • Tolterodine is the most popular first- and second-line drug treatment for SUI
  • Duloxetine is the most popular third-line drug treatment for SUI
  • Mixed urinary incontinence
  • Pharmacological versus non-pharmacological therapy
  • Treatment is usually based on the symptom that causes the greatest distress
  • Improving quality of life is the key goal when treating a patient with MUI
  • The majority of patients with MUI receive pharmacological therapy
  • Tolterodine and oxybutynin (immediate release) are the most popular first- and second-line drug treatment for MUI
  • Duloxetine is the most popular third-line drug treatment for MUI
  • Interstitial cystitis
  • Pharmacological treatment for IC
  • Tricyclic antidepressants are the most popular first-line drug treatment for IC
  • Oxybutynin (immediate release) is the most popular second-line drug treatment for IC
• Chapter 8 Drug Influences And Perception Of Current Treatments
  • Attributes that most influence prescribing choice
  • Physician perception of marketed products for OAB/UI
  • Physician perception of marketed drugs for OAB
  • Physician perception of marketed drugs for SUI
  • Physician perception of drugs for MUI
  • Physician perception of drugs for IC
  • Switch from first- to second-line therapy
  • Unmet needs
• Chapter 9 Pipeline Products
  • Pipeline overview
  • Physician awareness
• Appendix A
  • Key products in late-stage development
  • Staybla/Uritos (imidafenacin) (ONO-8025) (KRP-197)
  • Urespan (temiverine hydrochloride)
  • Fesoterodine
  • Phase II trials
  • Phase III
  • Esoxybutynin
  • Bibliography
  • Introduction
  • Epidemiology
  • Presentation and diagnosis
  • Current treatment
  • Pipeline Products
  • Websites
• Appendix B
  • Physician research methodology
  • Physician Sample breakdown
  • Urinary Incontinence and Overactive Bladder Insight Study - Physician Questionnaire
  • Section One Overview of Urinary Incontinence and overactive Bladder
  • Epidemiology
  • Presentation
  • Diagnosis
  • Referral pattern
  • Section Two Stress Urinary Incontinence
  • Diagnosis and treatment of SUI
  • Non-pharmacological treatment
  • Pharmacological treatment for SUI
  • Section Three Overactive Bladder With Urge Symptoms and/or Incontinence
  • Diagnosis and treatment of UUI
  • Pharmacological treatment for UUI
  • Diagnosis and treatment of 'dry OAB'
  • Pharmacological treatment for dry OAB
  • Section Four Mixed Stress/Urge Urinary Incontinence
  • Diagnosis and treatment of mixed SUI/UUI
  • Non-pharmacological treatment
  • Pharmacological treatment for mixed SUI/UUI
  • Section Five Interstitial Cystitis
  • Diagnosis and treatment of IC
  • Pharmacological treatment for IC
  • Section Six Drug Profiles
  • Section A: Drug influences on physicians' choice
  • Section B: The general treatment of urinary incontinence and overactive bladder
  • Urinary Incontinence and Overactive Bladder Insight Study - Continence nurse questionnaire
  • Section One Epidemiology
  • Section Two Presentation and help seeking behavior
  • Section Three Diagnosis and management
  • Referral pattern
  • Section Four Treatment
  • Non-pharmacological treatment
  • Pharmacological treatment
  • Section Five General
  • Section A: Drug influences
  • Section B: The general treatment of urinary incontinence and overactive bladder
  • Contributing experts
  • US
  • Japan
  • Europe
• Appendix C
  • About Datamonitor
  • About Datamonitor Healthcare
  • About the CNS analysis team
  • Disclaimer