Clostridium difficile infection (CDI) is a relatively common nosocomial
infection and is often implicated in antibiotic-associated diarrhea. This
infection has an important impact on the healthcare system due to increased
morbidity, costly hospitalizations, troubling rates of severe disease and
recurrent infections, and outbreaks caused by a new hypervirulent strain
of C. difficile, BI/NAP1/027. With limited therapeutic options available
and increasing reports of treatment failures, thought leaders and physicians
surveyed highlight the necessity for new, more-effective CDI therapies that
will not only treat the disease but will also prevent recurrences. In this
report, we investigate current treatment practices and risk factors for CDI and
analyze emerging therapies in the pipeline. In addition, we provide insight
into the current and future challenges associated with treating CDI, which we
gained from our survey of infectious disease specialists. Finally, we include a
market forecast of CDI events based on epidemiological findings, survey data,
and our understanding of the future market for CDI.
Questions Answered in This Report:
CDI affects a diverse
population of patients, and infections range in severity. What comorbid
conditions characterize the U.S. and European CDI patient populations? What are
the top risk factors for CDI? What are the most challenging CDI patient
populations to treat? What percentage of CDI patients require second- and
later-line therapy? What percentage of CDI patients have recurrent infections?
A variety of physicians treat CDI patients
in the hospital, and specialties vary by country. Which specialties are
responsible for treating CDI in the United States and Europe? For what
percentage of CDI patients and antibiotic courses are different specialties
responsible? Which specialties manage CDI patients after hospital discharge and
CDI patients treated in the outpatient setting?
Products and treatment patterns:
Only oral vancomycin
(ViroPharma’s Vancocin) and oral and intravenous metronidazole (Pfizer’s
Flagyl, Sanofi Aventis’s Rodogyl, generics) are commonly used to treat CDI.
However, different factors influence the use of each agent in CDI. How are
specific antibiotics used in CDI? What percentage of antibiotics are prescribed
for CDI by line of therapy? What are the most important attributes of oral
metronidazole that drive a physician to use it for CDI? What are the most
important attributes of oral vancomycin that drive a physician to use it for
CDI? What percentage of CDI patients receive vancomycin and metronidazole for
first-line, second-line, and recurrent therapy? Which antibiotics are most
commonly associated with subsequent CDI?
Several novel therapies are in development for
CDI. What are the most significant unmet needs in CDI? Which attributes
should the ideal CDI agent possess? How will emerging therapies be used in the
treatment of CDI? What are the current treatment patterns in CDI, and how will
these patterns change in the next ten years? Against which products will
new CDI agents primarily compete? What advantages do novel CDI therapies in the
pipeline offer? What does the future market for CDI look like? What changes in
CDI prescribing trends are foreseen by the infectious disease specialists we
Using clinical audit data
from the Arlington Medical Resources, Inc. (AMR), Hospital Antibiotic Market
Guide (HAMG), proprietary epidemiology, and insight from surveys of more
than 100 infectious disease specialists, we examine the use of antibiotics in
CDI, including the following:
- Analysis of the use of current agents used to treat CDI by
prescribing physician, line of therapy, and country (United States, France,
Germany, Italy, Spain, and United Kingdom).
- Prescribing behavior for the top specialties that prescribe
antibiotics for CDI in the United States and Europe.
- Patient comorbidities, hospitalization outcomes, settings in
which treatment occurs, and average duration of inpatient therapy in the United
States, France, Germany, Italy, Spain, and the United Kingdom.
We analyze the current marketplace and examine prescribing
drivers of the infectious disease specialists surveyed, their reasons for
prescribing key products, unmet needs, and their receptivity to emerging
antibiotics that may be of potential use in CDI.