根据全╲球领先的制药与医疗保健顾问公司Decision Resources日前发布的一份新报告，中国2型糖尿病治疗市场，将每年增长10%，并在2017年达到35亿美元。目前，中国是继美国、日本之后的全球第三大2型糖尿病治疗市场。
加剧这种扩张的因素有，越来越多的患者接受药物治疗，越来越多的使用二肽基肽酶-4(DPP-4)抑制剂、胰高血糖素样肽1(GLP-1)受体激动剂和胰岛素类似物。
在这卐份名为《中国2型糖尿病》(Type 2 Diabetes in China)的新兴市场(Emerging Markets)报告中，Decision Resources称，尽管可以预见到口服降糖药仿制药的进一步侵ζ 蚀，然而，近期推出的DPP-4抑制剂【默沙东(Merck & Co)的Januvia/Janumet(西格列汀，sitagliptin)，百时美施贵宝(BMS)/阿斯利康(AstraZeneca)的Onglyza(沙格列汀，saxagliptin)，诺华(Novartis)的Galvus(维格列汀，vildagliptin)】、GLP-1受体激动剂【百时美施贵宝/阿斯利康的Byetta(艾塞那肽，exenatide)，诺和诺德(Novo Nordisi)的Victoza(利拉鲁肽，liraglutide)】将继续享』有市场独占权，并在2012-2017年期间，攫◥取更高的患者份额(patient share)。
生物仿制胰岛素的影响预计不大
(Little impact expected from biosimilar insulins)
胰岛素类似物(包括长效和速效)的生物仿制药，在预测期内，对中国2型糖尿病市场仅有轻微影响⊙。大多数的生物仿制胰岛素价格，仅比品牌︽药的价格略低，这□鼓励了医生和患者继续保持使用品牌胰岛素。结合额外新型制剂的推出，到2017年，在中国2型糖尿病市场中，西方品牌疗法(Western-branded therapies)将一如既往地捕获超过「70%的销售。
这份报告还ㄨ揭示，中国医生对DPP-4抑制剂和GLP-1激动剂具有浓厚的兴趣。DPP-4抑制剂的青睐，是因为这类药物能有效改善血糖控制，同时无低血糖风险。GLP-1抑制剂，则能够有效降低糖】化血红蛋白(HbA1c)和体重，因此是肥胖2型糖尿病患者的理▆想选择。
然而，鉴于这2类药物高昂的价格和№报销的缺乏(lack of reimbursement)，当前，医生主要是处方这些药物用于2线或3线治疗，即患者使用不太昂贵的降糖药无法维持血糖控制时。同时，患者需要有良好的财务状况，来支付高昂的支出。
Decision Resources分析↓师吴静(音译)称，在中国，95%以上的居民拥有某种形式的政府资助的医疗保险，但这种广泛的医疗保险，并没有能够转化为可负担得起的医疗保健。选择性DPP-4抑制剂和GLP-1激动剂有一个合理的机会，被列入下〓一个版本的中国国家医保药品目录(NRDL)，该目录可能在2014年发布。然而，为了控制治疗费用，这些药物的报销，将被限制到特定的2型糖尿病患者群体。(生物谷Bioon.com)
英文原文：Growth drivers for Chinas type 2 diabetes market
The type 2 diabetes therapeutic market in China, the third largest after the USA and Japan, will grow 10% annually, reaching $3.5 billion in 2017, according to a new report from health care advisory firm Decision Resources.
Fueling this expansion are the growing number of drug-treated patients and the increasing use of dipeptidyl peptidase-4 (DPP-IV) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists and insulin analogues.
The Emerging Markets report, titled Type 2 Diabetes in China, finds that, although further generic erosion of older oral antidiabetics is expected, recently launched DPP-IV inhibitors (Merck & Cos Januvia/Janumet [sitagliptin], Bristol-Myers Squibb/AstraZenecas Onglyza [saxagliptin], Novartis Galvus [vildagliptin]) and GLP-1 receptor agonists (Bristol-Myers Squibb/AstraZenecas Byetta [exenatide], Novo Nordisks Victoza [liraglutide]) will continue to enjoy market exclusivity and garner higher patient share in China during the 2012-2017 period.
Little impact expected from biosimilar insulins
Biosimilar versions of insulin analogues, both long- and short-acting, will have only a modest impact on Chinas type 2 diabetes market during the forecast period. Most biosimilar insulins are only fractionally less expensive than the originators, which encourages physicians and patients to stay with branded insulins. Together with the launches of additional novel agents, Western-branded therapies will consistently capture more than 70% of sales in Chinas type 2 diabetes therapeutic market by 2017, Decision Resources predicts.
The findings also reveal that Chinese physicians show strong interest in DPP-IV inhibitors and GLP-1 receptor agonists. DPP-IV inhibitors are favored because of their improvement in glycemic control without the risk of hypoglycemia. GLP-1 receptor agonists are effective in lowering HbA1c and body weight and therefore are ideal for obese type 2 diabetes patients. However, due to their high prices and lack of reimbursement, physicians who currently prescribe them do so mostly in the second- or third-line setting, after their patients fail to maintain glycemic control with less expensive options. Meanwhile, patients need to be in good financial standing to afford the high out-of-pocket payment.
"More than 95% of Chinese residents have access to some form of government-sponsored medical insurance, but broad access does not translate into affordable health care," said Decision Resources analyst Jing Wu, adding:"Select DPP-IV inhibitors and GLP-1 receptor agonists have a reasonable chance of being included on the next version of the National Reimbursement Drug List (NRDL), likely to be released in 2014. However, in order to control treatment costs, the reimbursement of these agents will be restricted to specific type 2 diabetes patient groups."
