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In the ESA market, Amgen's Aranesp is the market share leader in both dialysis and CKD settings and is perceived to have numerous advantages compared to other ESAs. While the use of biosimilar ESAs did increase in the past six months, this was primarily driven by uptake in the German dialysis market. Almost half of the Nephrologists indicate a high concern with the quality of biosimilar ESAs and there appears to be ambivalence about this class of drugs -- only 20% of Nephrologists agree that they have a good understanding of the differences between biosimilar ESAs and their reference brands. Projected ESA share growth is most favorable for Roche's Mircera, particularly in France and Spain, with the greatest share loss coming from Roche's NeoRecormon. Although Aranesp is expected to see share decreases in almost all markets, Nephrologists project Aranesp will maintain its market leader position in both dialysis and CKD.
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In general, IV iron is reserved for patients on hemodialysis with about 65% of those treated receiving a consistent maintenance dose. The use of oral iron is more commonplace than the use of IV iron among CKD patients, but many CKD patients do not receive any iron therapy. Venofer and Ferrlecit are the most familiar brands to Nephrologists with market share varying by country. Newcomer Ferinject (ferric carboxymaltose) has yet to make in-roads with 84% of Nephrologists reporting no experience with the drug.
European Nephrologists rated new agents for hyperphosphatemia as one of the greatest unmet needs for their patients and report that at any given time more than one-third of their dialysis patients are above the target level for phosphorus. Calcium based phosphate binders are the most frequently prescribed binders in both dialysis and CKD, however, there is a high prevalence of combination binder therapy typically involving a calcium based agent combined with Genzyme's Renagel. Future share projections appear to favor Shire's Fosrenol which could be due in part to the diminishing concern with lanthanum absorption.
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