Bundling is Perceived as Negative by Many Nephrologists, and is Impacting the Management of Renal Anemia, According to a Recent Report from BioTrends

EXTON, Penn.--(BUSINESS WIRE)--The new dialysis bundled payment system that went into effect in January of this year, as expected, has had the greatest impact on the management of renal anemia, according to a recent report by BioTrends. Approximately one-half of nephrologists perceive the new payment system as negative and feel significant pressure to target lower hemoglobin levels and to limit the measurement of non-essential labs. The hemoglobin level at which nephrologists initiate and hold erythropoietin stimulating agents (ESAs) in dialysis patients has declined compared to both the prior year and prior quarter and nephrologists expect this to ultimately result in fewer hemodialysis patients being treated with ESAs in the next six months. Bundling also seems to be impacting ESA dosing frequency and method of administration. There have also been changes in the management of renal anemia in the chronic kidney disease non dialysis (CKD-ND) setting. Amgen’s Aranesp appears to be gaining momentum and is now the market leader among CKD-ND patients on ESAs and has a perceived competitive advantage compared to Centocor Ortho Biotech’s Procrit on a number of attributes. For the past several quarters, Procrit has suffered from declining monthly contact rates which seem to be impacting both product perception and, ultimately, market share.

Despite talks of increased use of intravenous (IV) iron in light of bundling, the percent of hemodialysis patients treated with IV iron has not changed. Interestingly though, the most commonly cited recent change regarding IV iron in the dialysis setting is increased ferritin and transferrin saturation (TSAT) levels leading to more use of IV iron and fewer patients being placed on hold. There have also been brand shifts in the hemodialysis IV iron market, which are particularly evident at the chain level. Market share for Fresenius’s Venofer has increased substantially compared to the prior year among nephrologists primarily affiliated with Fresenius units, share of Sanofi-Aventis’ Ferrlecit has increased substantially among nephrologists primarily affiliated with independent units, and share of AMAG’s Feraheme has decreased substantially among nephrologists primarily affiliated with small/medium dialysis organizations and independent units, where use of the product had been the greatest.

Nephrologists continue to report a high unmet need for a number of different conditions including acute kidney injury, diabetic nephropathy, lupus nephritis and hyperphosphatemia. They also report relatively high interest in a number of products in development including Reata / Abbott’s bardoxolone, HIF-PH inhibitors, Affymax / Takeda’s Hematide, and Rockwell’s Soluble Ferric Pyrophosphate.

TreatmentTrends^®: US Nephrology is a syndicated quarterly report series, based on primary market research, that provides a comprehensive view of the current and expected future management of renal anemia and bone and mineral metabolism in patients with kidney disease. The Q1 2011 wave was fielded with over 200 nephrologists in early March 2011. A parallel report covering the European Dialysis and CKD markets will be published in June.

About BioTrends Research Group, LLC

BioTrends Research Group, LLC provides syndicated and custom market research to pharmaceutical manufacturers competing in clinically evolving, specialty pharmaceutical markets. For information on BioTrends publications and research capabilities, please contact us at [phone] or www.bio-trends.com.

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