Multiple System Atrophy (MSA) - Market Insight, Epidemiology And Market Forecast - 2032

Multiple System Atrophy (MSA) - Market Insight, Epidemiology And Market Forecast - 2032

Key Highlights:

Multiple system atrophy (MSA) is a rapidly progressive synucleinopathies group of disorders characterized by abnormal deposition of the protein aS in the central and peripheral autonomic nervous system.

In 2022, the market size of MSA was highest in the US among the 7MM, accounting for approximately USD 84 million, which is further expected to increase by 2032.

The first line of treatment includes Levodopa, Adrenergic receptor agonists, and others (off-label therapies like Clonazepam, gabapentin, etc.).

While Adrenergic receptor agonists cover the larger market, making up the total market of around USD 50 million in 2022, in the 7MM.

MSA approximately accounted 36,000 cases in 2022 in the 7MM; the treatment market of MSA lacks approved therapy specific to MSA treatment.

Theravance Biopharma’s Ampreloxetine (TD-9855) is being developed for treating MSA patients with symptomatic neurogenic orthostatic hypotension (nOH). It is estimated to launch by 2027 in the US.

This emerging therapy has the potential to create a significant positive shift in the Multiple System Atrophy market size.

DelveInsight’s “Multiple System Atrophy – Market Insights, Epidemiology, and Market Forecast – 2032” report delivers an in-depth understanding of the Multiple system atrophy (MSA), historical and forecasted epidemiology as well as the Multiple System Atrophy market trends in the United States, EU4 (Germany, Spain, Italy, and France) and the United Kingdom, and Japan.

The MSA market report provides current treatment practices, emerging drugs, market share of individual therapies, and current and forecasted 7MM MSA market size from 2019 to 2032. The report also covers current MSA treatment practices/algorithms and unmet medical needs to curate the best opportunities and assess the market’s underlying potential.

Geography Covered

The United States

EU4 (Germany, France, Italy, and Spain) and the United Kingdom

Japan

Study period: 2019–2032

Multiple System Atrophy (MSA) Disease Understanding and Treatment Algorithm

Multiple system atrophy (MSA) overview

Multiple system atrophy (MSA) is a rare, rapidly progressing, fatal neurodegenerative disorder of uncertain etiology that is clinically characterized by a variable combination of Parkinsonism, cerebellar impairment, and autonomic and motor dysfunctions. Depending on the predominant clinical phenotype, the disease is sub-classified into a parkinsonian variant (MSA-P) associated with SND, a cerebellar (MSA-C) variant with OPCA with predominant cerebellar features, and a combination of both forms referred to as “mixed” MSA.

Multiple system atrophy (MSA) diagnosis

The accurate clinical diagnosis of MSA is based on a careful medical history and meticulous neurological examination. Ancillary investigations help support the diagnosis, rule out potential mimics, and define therapeutic strategies. This review summarizes diagnostic investigations useful in diagnosing MSA.

Current consensus guidelines include neuroimaging criteria for the diagnosis of possible MSA. These include the presence of atrophy of the putamen, middle cerebellar peduncle, pons, or cerebellum on brain magnetic resonance imaging (MRI), and putamen, brainstem or cerebellum hypo metabolism on brain fluorodeoxyglucose (FDG) positron emission tomography (PET), as well as dopaminergic denervation on PET or single photon emission computed tomography (SPECT).

Brain MRI is the gold standard imaging technique for evaluating parkinsonian and cerebellar syndromes, including MSA. A brain MRI, including standard sequences and diffusion-weighted imaging (DWI), should be included in the initial evaluation of every patient with suspected MSA. Several brain MR modalities are available.

Further details related to country-based variations are provided in the report

Multiple system atrophy (MSA) treatment

Current therapeutic management is based on symptomatic treatment. To date, no curative treatment is available for MSA.

Tremor, rigidity, bradykinesia, and postural instability are core features of MSA-P and are observed irrespective of subtype in nearly 90% of cases. A poor or unstained response to levodopa is common and among the core diagnostic features of MSA, helping differentiate MSA-P from PD. In one study, nearly a third of MSA-P patients benefit from levodopa therapy, but temporarily with a mean duration of 3.5 years. Levodopa remains the first-line therapy with a trial of up to 2 g total daily dose of levodopa (titrated from 100 mg to 300 mg 3–4 times daily) recommended for at least 3 months. A clinically significant improvement is a 30% decrease in the UMSARS. Levodopa may worsen OH or cause other more severe side effects less common among PD patients. Reports of deterioration with the medication withdrawal, even in the context of apparent nonresponse, are common and may justify the continuation of treatment.

Multiple System Atrophy (MSA) Epidemiology

As the market is derived using the patient-based model, the Multiple system atrophy (MSA) epidemiology chapter in the report provides historical as well as forecasted epidemiology segmented by total diagnosed prevalent cases of MSA, gender-specific diagnosed prevalent cases of MSA, age-specific diagnosed prevalent cases of MSA, and type-specific diagnosed prevalent cases of MSA in the 7MM covering the United States, EU4 countries (Germany, France, Italy, and Spain) and the United Kingdom, and Japan from 2019 to 2032. The total diagnosed prevalent cases of MSA in the 7MM comprised approximately 36,000 cases in 2022 and are projected to increase during the forecasted period.

The total diagnosed prevalent cases of MSA in the United States were around 15,000 cases in 2022.

The United States contributed to the largest diagnosed prevalent population of MSA, acquiring ~43% of the 7MM in 2022. Whereas EU4 and the UK, and Japan accounted for around 27% and 30% of the total population share, respectively, in 2022.

Among the EU4 countries, Germany accounted for the largest number of MSA cases, followed by France, whereas Spain accounted for the lowest number of cases in 2022.

In the 7MM, approximately 54% of the patient share is attributed to males, whereas the remaining 46% of females suffer from MSA.

A higher number of diagnosed cases were estimated in the 50–59 age group, suggesting that the prevalence of MSA increases with age.

According to DelveInsight estimates, based on type, there were around 21,000 cases of MSA-P, while for MSA-C, around 15,000 cases were estimated in the 7MM in 2022.

Multiple System Atrophy (MSA) Drug Chapters

The drug chapter segment of the Multiple System Atrophy (MSA) report encloses a detailed analysis of MSA-marketed drugs and late-stage (Phase-III and Phase-II) pipeline drugs. It also helps understand the MSA clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details, advantages and disadvantages of each included drug, and the latest news and press releases.

Emerging drugs

Ampreloxetine (TD-9855): Theravance Biopharma

Ampreloxetine is an investigational, once-daily Norepinephrine Reuptake Inhibitor (NRI) in development for treating patients with symptomatic neurogenic orthostatic hypotension (nOH). It has a high affinity for binding to norepinephrine transporters. By blocking the action of these transporters, ampreloxetine causes an increase in extracellular concentrations of norepinephrine.

Note: Detailed emerging therapies assessment will be provided in the final report.

Drug Class Insights

The current therapeutic management of Multiple System Atrophy (MSA) is based on symptomatic treatment and has witnessed little change for a decade. Considering the approved market segment, NORTHERA (droxidopa) is the world’s first approved therapy for symptomatic nOH.

Moreover, the upcoming treatment landscape is poised to see further expansion after the emergence of new classes, such as Ampreloxetine, which is in Phase III for treating patients with symptomatic neurogenic orthostatic hypotension. Lu AF82422, a monoclonal antibody, AAV2-GDNF, gene therapy is in the early phase of clinical investigation for MSA. Such novel drugs are expected to change the dynamics of the current treatment regime.

Multiple System Atrophy Market Outlook

Currently, no disease-modifying agent is approved. The drug used to treat PD (parkinsonism), most notably levodopa (SINEMET), is also prescribed for MSA individuals. However, the efficacy of such medications varies greatly among affected individuals. Apart from levodopa, other drugs used to treat PD may be used to treat MSA individuals. These include dopamine agonists such as ropinirole (Requip) and pramipexole (Mirapexin), which increase the activity of dopamine receptors in the brain. This helps the brain receive dopamine signals. Midodrine hydrochloride (ProAmatine) has been used to treat low blood pressure, sometimes associated with MSA. Adrenergic drugs such as ephedrine may be used to treat low blood pressure. L-threo-dihydroxyphenylserine (L-DOPS or L-threo-DOPS) can also treat low blood pressure.

The major challenge and unmet need in MSA treatment are that no drug is approved for the direct treatment of MSA. The key competitive factors that may affect the success of these products, and any other product candidates that are yet to reach the market, if approved, are likely to be efficacy, safety, convenience, cost, the availability of generic competition, and the reimbursement from government and/or other third-party payers.

Few new agents are being developed and tested as potential treatments for MSA; the emerging drugs include Ampreloxetine, Lu AF82422, AAV2-GDNF, and others.

The total market size of MSA in the 7MM was approximately USD 125 million in 2022 and is projected to increase during the forecast period (2022–2032).

The market size in the 7MM will increase at a constant CAGR due to increasing awareness of the disease, better diagnosis, and the launch of emerging therapy.

Among EU4 countries, Germany, with about USD 5 million, accounted for the maximum market size in 2022, while Spain occupied the bottom of the ladder with around USD 3 million in 2022.

Japan’s treatment market lacks approved targeted treatment for MSA, but with the expected approval of Ampreloxetine by 2029, the market is expected to experience positive growth.

Multiple System Atrophy (MSA) Drugs Uptake

This section focuses on the uptake rate of potential drugs expected to be launched in the market during 2019–2032. For example, for Ampreloxetine, we expect the drug uptake to be slow-medium with a probability-adjusted peak share of around 25%, and years to the peak is expected to be 6 years from the year of launch.

Further detailed analysis of emerging therapies drug uptake in the report…

Multiple System Atrophy (MSA) Pipeline Development Activities

The report provides insights into different therapeutic candidates in Phase III, Phase II, and Phase I stage. It also analyzes key players involved in developing targeted therapeutics.

Pipeline development activities

The report covers detailed information on collaborations, acquisitions and mergers, licensing, and patent details for Multiple System Atrophy (MSA) emerging therapies.

KOL Views

To keep up with current market trends, we take KOLs and SMEs’ opinions working in the domain through primary research to fill the data gaps and validate our secondary research. Industry experts contacted for insights on MSA evolving treatment landscape, patient reliance on conventional therapies, patient’s therapy switching acceptability, and drug uptake, along with challenges related to accessibility, include Medical/scientific writers, Medical Professors, the Director of Henry Mayo Newhall Memorial Hospital, and others.

DelveInsight’s analysts connected with 50+ KOLs to gather insights; however, interviews were conducted with 15+ KOLs in the 7MM. Centers such as the Brain Research Institute, University of California, University of Utah, Johannes-Gutenberg-University, etc., were contacted. Their opinion helps understand and validate current and emerging therapies and treatment patterns or MSA market trends. This will support the clients in potential upcoming novel treatments by identifying the overall scenario of the market and the unmet needs.

Qualitative Analysis

We perform qualitative and market Intelligence analysis using various approaches, such as SWOT and conjoint analysis. In the SWOT analysis, strengths, weaknesses, opportunities, and threats in terms of disease diagnosis, patient awareness, patient burden, competitive landscape, cost-effectiveness, and geographical accessibility of therapies are provided. These pointers are based on the analyst’s discretion and assessment of the patient burden, cost analysis, and existing and evolving treatment landscape.

Conjoint analysis is done to analyze multiple approved and emerging therapies based on relevant attributes such as safety, efficacy, frequency of administration, route of administration, and order of entry. Scoring is given based on these parameters to analyze the effectiveness of therapy.

Further, the therapies’ safety is evaluated wherein the acceptability, tolerability, and adverse events are majorly observed, and it sets a clear understanding of the side effects posed by the drug in the trials. In addition, the scoring is also based on the route of administration, order of entry and designation, probability of success, and the addressable patient pool for each therapy. According to these parameters, the final weightage score and the ranking of the emerging therapies are decided.

Market Access and Reimbursement

Reimbursement is a crucial factor affecting the drug’s market access. Often, the decision to reimburse comes down to the drug’s price relative to the benefit it produces in treated patients. NORTHERA patient support provides support to patients requiring NORTHERA prescription. According to this plan, the patient’s health insurance plan will determine the financial coverage, the amount they will pay for prescriptions, and additional savings they may be eligible for.

The report further provides detailed insights on the country-wise accessibility and reimbursement scenarios, cost-effectiveness scenario of approved therapies, programs making accessibility easier and out-of-pocket costs more affordable, insights on patients insured under federal or state government prescription drug programs, etc.

Report Metrics Details

Study Period 2019 to 2032

Base Year 2021

Forecast Period 2022 to 2032

CAGR Request Sample to Know

Market Size USD 125 Million in 2021

Key Companies H Lundbeck A/S, Theravance Biopharma, Brain Neurotherapy Bio, Inc, Ionis Pharmaceuticals, Inc., Alterity Therapeutics, and others

Scope of the Report

The report covers a segment of key events, an executive summary, descriptive overview of Multiple System Atrophy (MSA), explaining its causes, signs and symptoms, pathogenesis, and currently available therapies.

Comprehensive insight into the epidemiology segments and forecasts, the future growth potential of diagnosis rate, disease progression, and treatment guidelines have been provided.

Additionally, an all-inclusive account of the current and emerging therapies, along with the elaborative profiles of late-stage and prominent therapies, will impact the current treatment landscape.

A detailed review of the MSA market, historic and forecasted market size, market share by therapies, detailed assumptions, and rationale behind our approach is included in the report, covering the 7MM drug outreach.

The report provides an edge while developing business strategies, by understanding trends, through SWOT analysis and expert insights/KOL views, patient journey, and treatment preferences that help in shaping and driving the 7MM MSA market.

Multiple system atrophy (MSA) report insights

Patient population

Therapeutic approaches

Multiple system atrophy (MSA) pipeline analysis

Multiple system atrophy (MSA) market size and trends

Existing and future market opportunity

Multiple system atrophy (MSA) report key strengths

11 Years forecast

7MM coverage

Multiple system atrophy (MSA) epidemiology segmentation

Key cross competition

Attribute analysis

Drugs uptake and key market forecast assumptions

Multiple system atrophy (MSA) report assessment

Current treatment practices

Unmet needs

Pipeline product profiles

Market attractiveness

Qualitative analysis (SWOT and conjoint analysis)

Key Questions

Market insights:

What was the Multiple System Atrophy (MSA) total market size, the market size by therapies, and market share (%) distribution in 2019, and how would it look in 2032? What are the contributing factors for this growth?

What unmet needs are associated with the current treatment market of MSA?

How is Ampreloxetine going to compete with other treatments?

Which drug is going to be the largest contributor in 2032?

What are the pricing variations among different geographies for approved and off-label therapies?

How would the market drivers, barriers, and future opportunities affect the market dynamics and subsequent analysis of the associated trends?

Epidemiology insights

What are the disease risk, burden, and unmet needs of Multiple System Atrophy (MSA)? What will be the growth opportunities across the 7MM concerning the patient population of MSA?

What is the historical and forecasted MSA patient pool in the United States, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan?

Which type is more prevalent and why?

What factors are affecting the diagnosis of the indication?

Current treatment scenario, marketed drugs, and emerging therapies:

What are the current options for treating Multiple System Atrophy (MSA)? What are the current treatment guidelines for treating MSA in the US and Europe?

How many companies are developing therapies for the treatment of MSA?

How many emerging therapies are in the mid-stage and late development stage for treating MSA?

What are the recent novel therapies, targets, mechanisms of action, and technologies developed to overcome the limitation of existing therapies?

What key designations have been granted for the emerging therapies for MSA?

What is the cost burden of approved therapies on the patient?

Patient acceptability in terms of preferred treatment options as per real-world scenarios?

What are the country-specific accessibility issues of expensive, recently approved therapies? Focus on reimbursement policies.

What are the 7MM historical and forecasted market of MSA?

Reasons to buy

The report will help develop business strategies by understanding the latest trends and changing treatment dynamics driving the MSA market.

Insights on patient burden/disease prevalence, evolution in diagnosis, and factors contributing to the change in the epidemiology of the disease during the forecast years.

Understand the existing market opportunity in varying geographies and the growth potential over the coming years.

Distribution of historical and current patient share based on real-world prescription data along with reported sales of approved products in the US, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan.

Identifying strong upcoming players in the market will help devise strategies to help get ahead of competitors.

Detailed analysis and ranking of class-wise potential current and emerging therapies under the conjoint analysis section to provide visibility around leading classes.

Highlights of access and reimbursement policies of approved therapies, barriers to accessibility of expensive off-label therapies, and patient assistance programs.

To understand the perspective of key opinion leaders around the accessibility, acceptability, and compliance-related challenges of existing treatment to overcome barriers in the future.

Detailed insights on the unmet need of the existing market so that the upcoming players can strengthen their development and launch strategy.