EXTON, Pa., Oct. 27 /PRNewswire/ -- BioTrends Research Group, Inc. released two new Nephrology TreatmentTrends(TM) publications based on survey results from 204 Nephrologists and 201 Renal Dietitians in the US. Renal Dietitians (RDs) are an integral part of the management of dialysis patients, particularly in their role recommending and reinforcing adherence with Phosphate Binders, Active Vitamin D, and Calcimimetic agents.
In the phosphate binder market, the introduction of Genzyme's Renvela has given overall sevelamer share a boost compared to the same quarter last year, although most of the patients on Renvela have been switched from Renagel. Close to two-thirds of MDs and over three quarters of RDs have used Renvela in their hemodialysis patients, however, Renagel and FMC's PhosLo remain the two most frequently prescribed binders among dialysis patients. While sevelamer has the highest share across all types of dialysis units, Shire's Fosrenol does its best in Davita units whereas PhosLo does its best in Fresenius units. Nephrologists are divided as to their first line preference in dialysis -- approximately half choose a calcium-based binder and half choose a non-calcium based binder compared to over two-thirds of RDs who choose to start with a non-calcium based binder. In patients with Chronic Kidney Disease not on dialysis (CKD), 73% of Nephrologists prefer to start with calcium-based binders.
In the PTH modifier market, although RDs report a high level of influence in the choice of Vitamin D, approximately 80% report that their dialysis center generally encourages the use of Abbott's Zemplar, compared to only 29% who report they are encouraged to use Genzyme's Hectorol. While Zemplar IV is the overwhelming market share leader in hemodialysis and leads in every type of dialysis unit, Hectorol does its best in non-chains and its worst in Davita. In CKD, Nephrologists continue to use oral calcitriol most often. Compared to the prior year, RDs report a high and growing influence in decisions regarding the use of Sensipar. Treatment prevalence with Sensipar in hemodialysis patients, according to both MDs and RDs has been lingering at around 30%. While Sensipar is often used second line to Vitamin D, it does seem to impact Vitamin D dose, with the majority of RDs reporting that patients on Sensipar tend to be on lower doses of Vitamin D.
In the renal anemia market, Nephrologists seem to be settling into the new treatment standards (e.g., lower target hemoglobin levels, lower levels for ESA initiation, holds, and dose reductions) and more than two-thirds do not anticipate making any additional changes to their use of ESAs in CKD or dialysis. While Amgen's Epogen continues to dominate the dialysis market, there did seem to be some brand shifting between Amgen's Aranesp and Ortho Biotech's Procrit in CKD. Nephrologists do not predict significant changes in ESA market share in CKD or dialysis in the near-term, but they do project that bundling will have an impact on ESA use most likely through shifts to subcutaneous dosing and less aggressive treatment of EPO hypo-responders. New ESAs in development could also shift market dynamics particularly if these products are able to meet what Nephrologists identified as the most desired attributes in a new ESA.
In terms of IV iron, American Regent's Venofer remains the market leader in both dialysis and CKD, however, office-based Nephrologists report significantly higher CKD share for Venofer and hospital-based Nephrologists report significantly higher CKD share for Watson's Ferrlecit. In the dialysis market, very little brand switching took place in the past year, although 60% of Nephrologists primarily affiliated with Fresenius units expect their use of Venofer to increase following the news that Fresenius will be marketing and distributing Venofer in dialysis units. Awareness of AMAG Pharmaceutical's Ferumoxytol continues to be low. Among those familiar with the product, expected benefits center around dosing and administration, particularly for CKD patients. More than half of Nephrologists believe that the introduction of this new product will lead to an overall increase in their use of IV iron in CKD.
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