PUBLISHER: DelveInsight | PRODUCT CODE: 1415486
PUBLISHER: DelveInsight | PRODUCT CODE: 1415486
DelveInsight's "Achondroplasia - Market Insights, Epidemiology, and Market Forecast - 2032" report delivers an in-depth understanding of achondroplasia, historical and forecasted epidemiology, as well as the achondroplasia market trends in the United States, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan.
The achondroplasia market report provides current treatment practices, emerging drugs, market share of individual therapies, and current and forecasted 7MM achondroplasia market size from 2019 to 2032. The report also covers achondroplasia treatment practices/algorithms and unmet medical needs to curate the best opportunities and assess the market's potential.
Study Period: 2019-2032.
Achondroplasia is a rare genetic bone growth disorder that results in marked short stature (dwarfism) due to a mutation in the ?broblast growth factor receptor 3 (FGFR3) gene. The mutation leads to a gain-of-function of the FGFR3 gene, which slows down the formation of bone in the cartilage of the growth plate and impairs growth in almost all bones in the body.
It is inherited in an autosomal dominant pattern, and the gene is fully penetrant. The risk to offspring of an achondroplastic individual of inheriting a mutated copy of the FGFR3 gene is 50%. When both parents are affected, their offspring have a one in four (25%) chance of having normal stature, a one in two (50%) chance of having achondroplasia (heterozygous), and a one in four (25%) chance of homozygous achondroplasia. Moreover, the homozygous form is usually incompatible with life, resulting in early neonatal death from respiratory insufficiency due to a small thoracic cage and neurologic deficits from cervicomedullary stenosis. However, the condition occurs in over 80% of cases due to sporadic or de novo mutation. Thus, a child with achondroplasia can be born to healthy parents without a family history.
It is often diagnosed through physical examination and confirmed with genetic testing. The clinical and radiological features of achondroplasia are well-characterized and diagnostically helpful in neonates and young infants. Prenatal diagnosis is possible through genetic testing, allowing parents to make informed decisions about their child's healthcare. Further, differential diagnosis is done to rule out similar conditions like hypochondroplasia, pseudoachondroplasia, thanatophoric dysplasia, and others.
Further details related to country-based variations are provided in the report…
Management of achondroplasia requires a multidisciplinary approach involving an interprofessional team. There are no curative treatments for achondroplasia; however, treatment aims to relieve complications and provide symptomatic relief.
The current treatment landscape has only one approved therapy in the US and Europe, VOXZOGO (vosoritide), which is indicated to increase linear growth in pediatric patients with achondroplasia with open epiphyses. It is a C-type natriuretic peptide (CNP) analog, which acts as a positive regulator of the signaling pathway downstream of FGFR3 to promote endochondral bone growth.
In Japan, recombinant human growth hormone (r-hGH) therapy and VOXZOGO (vosoritide) are authorized for treating achondroplasia. However, the long-term benefits of r-hGh are controversial, and treatment with growth hormone does not largely affect the height of a person with achondroplasia.
As the market is derived using a patient-based model, the achondroplasia epidemiology chapter in the report provides historical as well as forecasted epidemiology segmented by total diagnosed prevalent cases of achondroplasia and gender-specific diagnosed prevalent cases of achondroplasia in the 7MM covering the United States, EU4 countries (Germany, France, Italy, and Spain) and the United Kingdom, and Japan from 2019 to 2032.
Among EU4 and the UK, France accounted for the highest cases of achondroplasia representing nearly 35% of the cases, followed by Germany, while Spain had the least cases in 2022.
According to DelveInsight's epidemiology model estimates, achondroplasia exhibits a significant female preponderance than males in EU4 and the UK. Of the total cases, nearly 46% were males and 54% were females.
The drug chapter segment of the achondroplasia report encloses a detailed analysis of achondroplasia-marketed drugs and mid to late-stage (Phase III and Phase II) pipeline drugs. It also helps understand the achondroplasia clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details, advantages and disadvantages of each included drug and the latest news and press releases.
VOXZOGO (vosoritide) is a CNP analog that increases linear growth in pediatric patients with achondroplasia with open epiphyses. In achondroplasia patients, the FGFR3 gene, which controls growth, is permanently turned on, hindering the normal formation of bones and resulting in shorter-than-normal bones. VOXZOGO binds to the receptor called natriuretic peptide receptor-B (NPR-B) and antagonizes FGFR3 downstream signaling by inhibiting the extracellular signal-regulated kinases 1 and 2 (ERK1/2) in the mitogen-activated protein kinase (MAPK) pathway and accelerate fibrosarcoma serine/threonine (RAF-1). The drug was approved in 2021 the US and Europe, while in Japan, it was approved in 2022.
The recommended dosage of VOXZOGO is based on the patient's actual body weight and is administered by subcutaneous injection (SC) once daily. The concentration of vosoritide is to be reconstituted before usage, depending upon the body weight, 0.4 mg vial and 0.56 mg vial to 0.8 mg/mL, while the concentration of 1.2 mg vial is reconstituted to 2 mg/mL.
BioMarin received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) in Europe to expand the use of VOXZOGO (vosoritide) to treat children aged 4 months and older with achondroplasia late in 2023. However, a final approval decision, typically consistent with the CHMP recommendation, is expected from the European Commission in the fourth quarter of 2023 based on positive results from global Phase II and ongoing extension study.
BioMarin also plans to begin enrollment in the pivotal program with VOXZOGO to treat children with hypochondroplasia. Moreover, they are also preparing to initiate two additional clinical programs in 2024 with VOXZOGO, one in idiopathic short stature and one in genetic short stature conditions (BioMarin, 2023c).
Additionally, VOXZOGO is being tested in Phase I/II for safety and efficacy data of growth deficits in Morquio syndrome (mucopolysaccharidosis IVA/ MPS-IV) and Phase II trial for short stature in Turner Syndrome.
TransCon CNP is a novel long-acting CNP prodrug that comes in a convenient once-weekly SC dose and is intended to offer therapeutic amounts of continuous CNP exposure. It is being developed for the treatment of children with achondroplasia. TransCon CNP is made to effectively shield CNP from neutral endopeptidase degradation in the blood compartment and SC tissue. It also reduces CNP binding to the natriuretic peptide receptor (NPR-B) receptor in the cardiovascular system, preventing hypotension, and minimizes CNP binding to the NPR-C receptor to decrease clearance. Lastly, it releases unmodified CNP, which is small enough to penetrate growth plates effectively.
The drug is undergoing a pivotal Phase II/III ApproaCH trial, with expected results in the second half of 2024. The drug is also being investigated in two other trials, ACcomplisH and AttaCH. The 1-year follow-up data from AComplisH OLE is expected in the fourth quarter of 2023.
Further, the company has filed an IND amendment with the FDA to initiate reACHin, a Phase II trial, designed to evaluate the safety, tolerability, and efficacy of 100 µg/kg of TransCon CNP once weekly for 52 weeks in infants of age 0-2 years with achondroplasia. Moreover, the company expects to submit an IND application in the fourth quarter of 2023 for COACH, a combination trial evaluating TransCon CNP and TransCon hGH in children with achondroplasia.
Note: Detailed emerging therapies assessment will be provided in the final report.
Achondroplasia is a genetic disorder characterized by abnormal bone development, resulting in dwarfism and distinct physical features. It follows an autosomal dominant inheritance pattern, where a single copy of the mutated gene is sufficient to cause the condition. It is associated with increased mortality in early childhood, otolaryngology problems later in childhood, and increased risk of obesity into adulthood. Affected individuals can also develop joint laxity, thoracolumbar kyphosis (TLK), and spinal stenosis that may progress and contribute to morbidity as an adult. Management of achondroplasia involves an interprofessional team approach, and anticipatory care is essential. Statins, CNP analogs, growth hormones, and antihistamines are different classes of medications used to manage complications and symptoms of achondroplasia.
C-type natriuretic peptide (CNP) antagonizes FGFR3 downstream signaling by inhibiting the mitogen-activated protein kinase (MAPK) pathway. VOXZOGO (vosoritide) is the only US FDA-approved CNP analog therapy to increase linear growth in children with achondroplasia and open growth plates.
Besides pharmacological treatment, several surgical options are used to manage the different complications of achondroplasia; macrocephaly, a common complication of achondroplasia in children, is surgically corrected by endoscopic third ventriculostomy, ventricular shunt, or posterior fossa decompression.
The adequate management of achondroplasia involves a multidisciplinary approach; due to the different comorbidities of individuals, different care approaches are required; several specialists like pediatrics, endocrinologists, medical geneticists, ENT specialists, orthopedics, neurosurgeons, and others are needed. A few treatment guidelines and recommendations have been developed that aid in the informed evaluation and management of achondroplasia, including the American Academy of Pediatric's Health Supervision for Children with Achondroplasia, International Consensus Statement on the Diagnosis, Multidisciplinary Management, and Lifelong Care of Individuals with Achondroplasia, and Japanese Society for Pediatric Endocrinology's Clinical Practice Guidelines for Achondroplasia.
The current treatment landscape of achondroplasia lacks curative therapies and involves both pharmacological and nonpharmacological options. Different treatment is directed against the specific issues encountered in achondroplasia. Pharmacological intervention includes treatment with CNP analogs and other symptomatic medications for managing complications. Further, growth hormone therapy may be considered as a treatment option for achondroplasia; however, its long-term benefits are controversial and are only authorized in Japan.
The treatment of achondroplasia in Europe and Japan is similar to that of the US. Europe also has only one approved drug, VOXZOGO, which was authorized before its approval in the US. In August 2021, the EMA approved the treatment of children with achondroplasia starting at the age of 2 years until the closure of growth plates, which occurs after puberty. On the contrary, in Japan, the drug was approved in 2022 for treating achondroplasia in children of all ages whose growth plates are not closed. Earlier, recombinant human growth (r-hGH) was the only approved therapy for achondroplasia in Japan. r-hGH therapy was initially approved for Turner syndrome associated with GHD, and later, the indications for r-hGH treatment expanded to include other growth disorders involving normal GH secretion, including short stature in children with chronic renal failure and achondroplasia/hypochondroplasia in 1997.
The current market has been segmented into VOXZOGO (vosoritide) and other therapies, including statins, antihistamines, CNPs, growth hormones, etc. These are the major drugs covered in the forecast model.
Key players Ascendis Pharma's TransCon CNP (navepegritide), QED Therapeutics (BridgeBio) and Novartis' infigratinib (BBP-831/BGJ398), Sanofi's SAR442501, and RIBOMIC's RBM-007 are evaluating their lead candidates in different stages of clinical development. They aim to investigate their products to treat achondroplasia.
This section focuses on the uptake rate of potential drugs expected to be launched in the market during 2019-2032. For example, QED Therapeutics (BridgeBio) and Novartis' Infigratinib (BBP-831/BGJ398), a FGFR 1-3-selective tyrosine kinase inhibitor, is expected to enter the US market by 2026 and is projected to have a medium uptake during the forecast period.
Further detailed analysis of emerging therapies drug uptake in the report…
The report provides insights into different therapeutic candidates in Phase III, Phase II, and Phase I. It also analyzes key players involved in developing targeted therapeutics.
The report covers information on collaborations, acquisitions and mergers, licensing, and patent details for emerging therapies for achondroplasia.
To keep up with current market trends, we take KOLs and SMEs' opinions working in the domain through primary research to fill the data gaps and validate our secondary research. Industry Experts contacted for insights on achondroplasia's evolving treatment landscape, patient reliance on conventional therapies, patient therapy switching acceptability, and drug uptake, along with challenges related to accessibility, including Medical/scientific writers, Medical Professionals, Professors, Directors, and Others.
DelveInsight's analysts connected with 50+ KOLs to gather insights; however, interviews were conducted with 15+ KOLs in the 7MM. Centers like the University of Wisconsin School of Medicine and Public Health, University of California, University Medical Center Hamburg-Eppendorf, University of Genova, St. George's University of London, and the University of Tokyo were contacted. Their opinion helps understand and validate current and emerging therapy treatment patterns or achondroplasia market trends. This will support the clients in potential upcoming novel treatments by identifying the overall scenario of the market and the unmet needs.
According to our primary research analysis, though there was a lack of approved therapies before 2021, it was found that several off-label medications, including statins, antihistamines, and growth hormones, were used for the management of complications and symptoms of achondroplasia. A few studies suggested that statins could correct the degraded cartilage in chondrogenically differentiated thanatophoric dysplasia type I and achondroplasia-induced pluripotent stem cells. Further, treatment of achondroplasia model mice with statin led to a significant recovery of bone growth. Meclizine, an antihistamine, is usually used to relieve the symptoms of travel sickness or dizziness and has an additional mechanism to block the ERK1/2-MAPK pathway, which inhibits the activity of FGFR3. It is being used to treat achondroplasia in children; however, its efficacy has not yet been established. Recombinant somatotropin is a symptomatic treatment method for short stature in achondroplasia. It aims to enhance the patients' growth via direct action or through the effect of insulin-like growth factor-1 on chondrocyte proliferation. However, the market regime changed in 2021 after the approval of VOXZOGO (vosoritide), a CNP analog, and is being used to promote endochondral bone growth. However, there is an urgent need for therapies that restore skeletal growth and improve quality of life by significantly reducing the burden of complications.
The current pipeline contains CNP analog, monoclonal antibody, peptide aptamers, and a small molecule that targets different pathways in achondroplasia. The entry of these drugs will provide different options relating to patient-specific needs. Further, the entry of these molecules will end the monopoly of VOXZOGO (vosoritide).
We perform Qualitative and market Intelligence analysis using various approaches, such as SWOT and Conjoint Analysis. In the SWOT analysis, strengths, weaknesses, opportunities, and threats in terms of disease diagnosis, patient awareness, patient burden, competitive landscape, cost-effectiveness, and geographical accessibility of therapies are provided. These pointers are based on the Analyst's discretion and assessment of the patient burden, cost analysis, and existing and evolving treatment landscape.
Conjoint Analysis analyzes multiple emerging therapies based on relevant attributes such as safety, efficacy, frequency of administration, route of administration, and order of entry. Scoring is given based on these parameters to analyze the effectiveness of therapy.
In efficacy, the trial's primary and secondary outcome measures are evaluated; for instance, in achondroplasia trials, efficacy scores are according to the change from baseline in annualized height/growth velocity (cm/year).
Further, the therapies' safety is evaluated wherein the acceptability, tolerability, and adverse events are majorly observed. It sets a clear understanding of the side effects posed by the drug in the trials. In addition, the scoring is also based on the route of administration, order of entry and designation, probability of success, and the addressable patient pool for each therapy. According to these parameters, the final weightage score and the ranking of the emerging therapies are decided.
Reimbursement of rare disease therapies can be limited due to lack of supporting policies and funding, challenges of high prices, lack of specific approaches to evaluating rare disease drugs given limited evidence, and payers' concerns about budget impact. The high cost of rare disease drugs usually has a limited effect on the budget due to the small number of eligible patients being prescribed the drug. The US FDA has approved several rare disease therapies in recent years. From a patient perspective, health insurance and payer coverage guidelines surrounding rare disease treatments restrict broad access to these treatments, leaving only a small number of patients who can bypass insurance and pay for products independently.
The reimbursement challenges related to medical care and treatment for individuals with achondroplasia can be significant as it often requires specialized medical attention, covering the costs of diagnosis, treatment, and ongoing care. Health insurance plans may not fully cover limited coverage of some medical treatments, therapies, and devices specific to achondroplasia. This can result in high out-of-pocket expenses for families seeking the best care for their loved ones. Moreover, it requires specialized care from healthcare providers with expertise. Finding and accessing such specialists may be challenging, and the associated costs may not always be fully reimbursed by insurance.
Many individuals may also require orthopedic interventions, such as limb lengthening or corrective surgeries. These surgeries can be expensive, and reimbursement for these specialized procedures can be an obstacle. Furthermore, GH therapy is used to help children grow taller and costs a lot. In addition, individuals with achondroplasia may benefit from counseling or psychological support to address issues related to self-esteem, body image, and social challenges. Mental health services may have reimbursement limitations.
The recently approved BioMarin's VOXZOGO co-pay assistance program is running in the US. With other initiatives, including VOXZOGO reimbursement in Italy (AIFA), France's HAS Transparency Committee Summary, and others.
The program covers up to USD 17,000 annually for eligible families in co-pay assistance. It includes all VOXZOGO (vosoritide) co-pay costs up to the annual maximum. Additionally, eligible families may pay as little as USD 0 for VOXZOGO prescriptions.
The report provides detailed insights on the country-wise accessibility and reimbursement scenarios, cost-effectiveness scenarios, programs making accessibility easier and out-of-pocket costs more affordable, insights on patients insured under federal or state government prescription drug programs, etc.