European Neuropathic Pain neuralgia

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                                                         Providing an
This new EP Publications report:

   Provides patient populations with
                                                         Enhanced Perspective...
   key conditions causing neuropathic
   pain in each of the five major                        On
   European country-markets in 2008,


                                                         European
   2013, and 2018

   Reports on interviews with thought-
   leading physicians regarding the


                                                         Neuropathic Pain
   treatment of neuropathic pain in
   the five major European country-
   markets

   Presents expert analysis of the
   commercial potential and key
   differences among products in
                                                         2008
   development for the treatment of
   neuropathic pain

   Forecasts the potential value of the
                                                         2nd Edition
   neuropathic pain market in each
   country, by etiology and by drug
   class

   Reveals the critical factors driving
                                                         Commercial Potential Driven by Clinical Need 
   neuropathic pain market growth
   through 2018

New for 2008 report:

Two New Chapters                                         About WWMR, Inc.
   Fibromyalgia
                                                         WWMR, Inc., is a leading marketing research and strategic consulting firm with global
   Neuropathic Cancer Pain                               capabilities. Since 1994, WWMR, Inc., has provided high-quality, insightful proprie-
                                                         tary studies to clients in the pharmaceutical, biotech, medical device, and diagnostics
                                                         industries worldwide. Using primary and secondary research methodologies, WWMR,
                                                         Inc., provides market opportunities and product assessments, competitive intelligence,
                                                         forecasts, population projections, pre-launch product planning, post-launch product
                                                         monitoring, product pricing strategy, database products, and on-site information center
                                                         management. Enhanced Perspective Publications (EP Publications) is the multi-client
                                                         service of WWMR, Inc. 




                    2929 Campus Drive, Suite 200  San Mateo, CA 94403   Toll free (888) 947‐2339  Fax (650) 312‐1570   Michelle_Nordstrom@wwmr.com www.wwmr.com    
                                                                Providing an Enhanced Perspective

 EUROPEAN NEUROPATHIC PAIN
An Opportunity to Meet Unmet Need for Therapy                                                   Post-Herpetic Neuralgia

By 2018, there will be almost 2 million individuals in the five major                           Trigeminal Neuralgia

European pharmaceutical markets—France, Germany, Italy, Spain                                   HIV/AIDS Neuropathy
and the UK—suffering from major neuropathic pain conditions.                                    Fibromyalgia
Given this substantial patient population, neuropathic pain has re-
                                                                                                Neuropathic Cancer Pain
ceived particular attention in recent years due to its relative resis-
tance to conventional analgesic therapies.                                                Expert analysis and commentary describing the future neuropathic
                                                                                          pain market are based on:
The European neuropathic pain market is characterized by a particu-
larly high level of unmet need for effective therapeutics due to the                            In-depth analysis of the medical literature, including treatment
under-utilization of anti-depressants, the lack of opioid availability,                         review articles, medical textbooks, epidemiology studies, and
commonly used to treat neuropathic pain in the U.S. and certain                                 clinical studies.
European country-markets, but not others. This under-utilization stems
                                                                                                Thorough review of country-specific and overall trends
primarily from a lack of awareness about the potential utility of these
drugs in neuropathic pain treatment and concerns about opioid ad-                               Comprehensive analysis of prescriptions written for specific
diction.                                                                                        conditions, including estimations of prescription size, number of
                                                                                                refills, and cost
The anticonvulsant Neurontin (gabapentin) has recently experienced
significant uptake in some countries in Europe, demonstrating the                               Evaluation of drugs in the neuropathic pain drug pipeline, with
magnitude of the potential for other drugs with newer mechanisms of                             conclusions on the future directions in treatment
action. Now the product facing generic competition in Europe, and
                                                                                                Interviews with leading international clinicians and researchers,
with Pfizer’s recent NDA submission to the US FDA for the follow-on
                                                                                                including medical director 
drug pregabalin, renewed attention is being focused on anticipated
changes in the neuropathic pain market.                                                   WWMR’s European Neuropathic Pain report will allow
                                                                                          pharmaceutical and biotechnology executives to:
Report Objectives & Methodology
                                                                                                Pinpoint the specific conditions causing neuropathic pain that
In this report WWMR, Inc., provides an assessment for five major
                                                                                                have high market potential in the next 10 years
conditions causing neuropathic pain in the five major European
pharmaceutical markets:                                                                         Understand the characteristics of the unmet need in the neuro-
                                                                                                pathic pain market in Europe as well as the key differences
     France                          Spain
                                                                                                between markets in France, Germany, Italy, Spain, and the UK
     Germany                         UK
                                                                                                Compare the epidemiology and forecasted prevalence of neuro-
     Italy
                                                                                                pathic pain, among the 5 major European pharmaceutical mar-
This report also summarizes WWMR, Inc.’s current understanding of                               kets
neuropathic pain mechanisms, and highlights promising targets for
drug development. Also discussed are new treatments already in                                  Target specific patient populations that will benefit most from
development that offer the promise of improved pain management of                               drugs in the neuropathic pain pipeline
neuropathic pain in the near future.                                                            Anticipate upcoming competitors and product licensing opportu-
Models representing patient populations and the commercial value                                nities
(USD) of this market in 2008, 2013, and 2018 are assessed. These                                Recognize the impact of unique market dynamics, including
models describe the important features of key conditions causing                                patent expiration, and the potential off-label usage, on product
neuropathic pain:                                                                               uptake forecasts
     Neuropathic Back Pain                                                                      Develop condition-specific and country-specific forecasts for
     Diabetic Neuropathy                                                                        major conditions associated with neuropathic pain

    About EP Publications
Enhance your perspective through EP Publications, a service of WWMR, Inc. Each report pinpoints and evaluates key trends and markets, ena-
bling clients to identify opportunities and augment strategic decisions. In-house consultants with industry experience use qualitative and quan-
titative research methodologies to provide the most comprehensive and insightful business intelligence available in the life sciences industry. 




                     2929 Campus Drive, Suite 200  San Mateo, CA 94403   Toll free (888) 947‐2339  Fax (650) 312‐1570   Michelle_Nordstrom@wwmr.com www.wwmr.com    
                                                                      Providing an Enhanced Perspective

    TABLE OF CONTENTS                              EUROPEAN NEUROPATHIC PAIN
NEW IN 2008                                                     D. Trigeminal Neuralgia                                                   3.4 GABA receptor agonists
Two new chapters:                                                  1. Trigeminal neuralgia                                                3.5 Cyclo-oxygenase 2, 5-Lipooxygenase and
     Fibromyalgia                                                  2. Incidence                                                                Platelet Sctivating Factor Inhibitors
     Neuropathic Cancer Pain                                       3. Basis for target population                                         3.6 Cholecystokinin antagonists
I. EXECUTIVE SUMMARY                                               4. Five-Country trigeminal neuralgia population
                                                                                                                                          3.7 Free Radical Scavengers and
II. INTRODUCTION AND METHODOLOGY                                      projections
                                                                                                                                               Mtogen-Activated Protein Kinade Inhibitors
III. PHYSIOLOGY OF PAIN                                         E. HIV/AIDS Neuropathic Pain
                                                                                                                                          3.8 Nicotinic Acetylcholine Receptor Agonists
  A. Definition of Neuropathic Pain                                1. HIV/AIDS Pain
                                                                                                                                          3.9 Adenosine A1 Receptor Agonists
     1. Nerve injury                                               2. HIV/AIDS incidence and prevalence
                                                                                                                                          3.10 Nociceptin Antagonists and Vanilloid
     2. Long duration                                              3. AIDS incidence and prevalence
                                                                                                                                                Receptor Agonists
     3. Abnormal sensations                                        4. HIV/AIDS pain prevalence
                                                                                                                                          3.11 Alpha 2 Adrenoceptor Agonists
     4. Aggravation by physiological processes                     5. HIV/AIDS neuropathic pain prevalence
                                                                                                                                          3. 12 Undefined Mechanisms
     5. Cellular mechanisms of neuropathic pain                    6. Basis of target population projections
                                                                                                                                        4. Phase I
        5.1 Peripheral Mechanisms of Neuropathic                   7. US HIV/AIDS neuropathy population
                                                                                                                                          4.1 GABA Receptor Agonist
            Pain                                                      projections
                                                                                                                                          4.2 NMDA Antagonist and Momoamine
        5.2 Spinal Cord Mechanisms of Neuropathic                  8. Fibromyalgia
                                                                                                                                               Oxidase Inhibitors
            Pain                                                   9. Neuropathic Cancer Pain
                                                                                                                                          4.3 Neurotrsnmitter Agonists
        5.3 Mechanisms of Central Neuropathic Pain           VI. APPROACHES TO TREATMENT OF NEURO-
                                                                                                                                          4.4 Ion Channel Modulators
  B. Definition of Neuropathic Pain States                   PATHIC PAIN
                                                                                                                                          4.5 Superoxide Dismutase Stimulants
     1. Neuropathic Low-Back Pain                               A. Actual Clinical Practice
                                                                                                                                          4.6 Cannabinoid CB1 Receptor Agonists
     2. Diabetic Neuropathy                                        1. Antidepressants
                                                                                                                                          4.7 Undefined Mechansism
     3. Post-Herpetic Neuralgia                                    2. Anticonvulsants
                                                                                                                                          4.8 Antioxidants
     4. Trigeminal Neuralgia (tic doulourex)                       3. Local anesthetics, regional nerve blocks,
                                                                                                                                          4.9 Discontinued, Suspended, or No
     5. HIV/AIDS Neuropathy                                           and sympathetic nerve blocks
                                                                                                                                               Development Reported Drugs
IV. MEASUREMENT OF PAINFUL CONDITIONS                              4. Antiarrhythmics
                                                                                                                                    G. References
  A. Pain Measurement Scales                                       5. Non-narcotic synthetic opioids
                                                                                                                                 VII.   MARKET FORECASTS AND ESTIMATES,
     1. Qualitative assessments                                    6. Opioids and semi-synthetic narcotics
                                                                                                                                 CURRENT AND FUTURE
     2. Standard quantitative pain measurement scales              7. Muscle relaxants
                                                                                                                                    A. Current Sales of Pharmaceutical Products,
        2.1 Visual analog scale (VAS)                              8. NMDA receptor antagonists
                                                                                                                                        By Drug Class and Condition
        2.2 McGill Pain Questionnaire (MPQ)                        9. VR-1 receptor agonists
                                                                                                                                        1. Five-Country Market Analysis:
        2.3 The neuropathic pain scale (NPS)                       10. Non-steroidal anti-inflammatory agents
                                                                                                                                          1.1 Anticonvulsants
  B. Clinical Assessment of Neuropathic Pain                            (NSAIDS)
                                                                                                                                          1.2 Antidepressants
V. EPIDEMIOLOGY - CURRENT AND FUTURE                               11. Non-pharmacologic treatments
                                                                                                                                          1.3 Opioids
  A. Neuropathic Back Pain                                            11.1 Electrical nerve stimulation
                                                                                                                                          1.4 Other
     1. Low-back pain                                                 11.2 Acupuncture
                                                                                                                                        2. European Market Summary
     2. Low-back pain incidence and prevalence                        11.3 Hypnosis and psychological approaches
                                                                                                                                          2.1 Clinician Views
     3. Chronic low-back pain prevalence                              11.4 Surgery
                                                                                                                                          2.2 Sales by Condition, Class & Country
     4. Neuropathic, chronic low-back pain                      B. Clinical Practice Guidelines
                                                                                                                                        3. Five-Country Market Analysis: Details by Class
        prevalence                                              C. Limitations of Current Treatment
                                                                                                                                          3.1 Neuropathc Back Pain
     5. Basis of target population                              D. Promising New Approaches
                                                                                                                                          3.2 Trigeminal Neuralgia
     6. Five-Country neuropathic, chronic low-back              E. Future Trends
                                                                                                                                          3.3 Diabetic Neuropathic Pain
        pain population projections                             F. Drugs in Clinical Development to Treat
                                                                                                                                          3.4 Post-Herpetic Neuralgia
  B. Diabetic Neuropathy                                           Neuropathic Pain
                                                                                                                                          3.5 HIV/AIDS Neuropathic Pain
     1. Diabetic neuropathy                                        1. Recent changes in the pipeline
                                                                                                                                        4. Methodology
     2. Diabetes prevalence                                        2. Current Pipeline
                                                                                                                                    B. Market Forecasts for Neuropathic Pain
     3. Diabetic neuropathy prevalence                                2.1Phase III, Preregistration, and Registration
                                                                                                                                        1. Five-Country market Forecast—2013 & 2018
     4. Symptomatic diabetic neuropathy prevalence                    2.2 Ion channel antagonists
                                                                                                                                          1.1 Anticonvulstants
     5. Diabetic neuropathic pain prevalence                          2.3 Glutamate receptor antagonists
                                                                                                                                          1.2 Antidepressants
     6. Basis of target population projections                        2.4 Cyclo-Oxygenase Inhibitors
                                                                                                                                          1.3 Opioids
     7. Five-Country diabetic neuropathy population                   2.5 Cannabinoid receptor agonists
                                                                                                                                          1.4 Other
        projections                                                   2.6 Neuromuscular blocking agents
                                                                                                                                        2. European Total Market Forecasts for Pipeline
  C. Post-Herpetic Neuralgia                                          2.7 Norepinephrine and Serotonin Reuptake
                                                                                                                                          products for the Treatment of Neuropathic Pain
     1. Post-herpetic neuralgia                                                Inhibitors
                                                                                                                                 VIII. APPENDICES
     2. Herpes zoster incidence                                       2.8 Alpha Adrenoceptor Agonist

     3. Post-herpetic neuralgia incidence                          3. Phase II

     4. Post-herpetic neuralgia prevalence                            3.1 Glutamate/NMDA receptor antagonists

     5. Basis of target population projections                        3.2 Ion channel antagonists

     6. Five-Country post-herpetic neuralgia population               3.3 Opioid Receptor Agonists

        projections




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