Clinical and Experimental Vision and Eye Research

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Pharmaceutical ophthalmic market perspectives in Indiaand emerging trends
Pharmaceutical ophthalmic market perspectives in India
and emerging trends
Varsha Narayanan
DGM Medical Services, Lupin Ltd., Mumbai, Maharashtra, India
Address for correspondence: Dr. Varsha Narayanan, DGM Medical Services,Lupin Ltd., Mumbai, Maharashtra, India.
Received: 11-02-2018
Accepted: 19-03-2018
doi: 10.15713/ins.clever.7
Ophthalmic pharmaceutical markets are expanding and growing globally and in India.This review article gives a glimpse of the current pharmaceutical market globally andcompares the international ophthalmic drug markets with the scenario in India withfurther insights into the relative contribution and growth from individual ophthalmictherapy segments as well as a look at future ophthalmic drug pipeline.
How to cite this article: Narayanan V. Pharmaceuticalophthalmic market perspectives in India and emerging trends.Cli Exp Vis Eye Res J 2018;1(1):35-37.

India's Growing Presence in the Global
Pharmaceutical Market

By 2020, the global pharmaceutical market is anticipated tomore than double to US$1.3 trillion at a 5% compound annualgrowth rate (CAGR), with the E7 countries - Brazil, China, India,Indonesia, Mexico, Russia, and Turkey accounting for around onefifthof global pharmaceutical sales.[1,2] India is likely to be amongthe top three pharmaceutical markets by incremental growth andsixth largest market globally in absolute size.[3,4] In March 2018, thepharmaceutical market grew at 9.5%year on year with sales of Rs.10,029 crore (US$ 1.56 billion). While India ranks tenth globally interms of value, it is ranked third in volumes. Increase in the numberof middle-class households, advance in medical infrastructure, andincrease in the penetration of health insurance in the country willplay a role in influencing this growth. During the period of April2017-February 2018, India exported pharmaceutical productsworth Rs. 767.17 billion (US$ 11.90 billion) with this numberexpected to reach US$ 40 billion by 2020. Indian drugs are exportedto >200 countries in the world, with the US as the key market,followed by Europe, Africa, and other Asian countries. India is theworld's largest provider of generic medicines; the country's genericdrugs account for 70-80% of the domestic retail market and 20% ofglobal generic drug exports in terms of volumes.

Overview of Ophthalmic Markets

The global ophthalmology market is dominated by ophthalmicdevices and equipment which make up almost US$ 47 billion. 25%of this market is contributed by surgical devices. India's currentophthalmic market is about US$ 1.3 billion expected to grow at aCAGR of 5-6.8% against a global growth of 4.06%.[5] The largestsubmarkets in terms of revenue in India are cataract surgery anddiagnostic equipment, followed by dry eye and glaucoma, the lattertwo leading the ophthalmic drug market. In 2017, alone 7.1 millioncataract procedures took place, with revenues expected to generatemore than a quarter of the total ophthalmic market revenues inthe country.[6,7] The diagnostic equipment market is the secondlargest ophthalmic market in India and is expected to reach nearly$257 million in 2022. The glaucoma segment is the fastest growingophthalmic pharmaceutical submarket in India and is expected to be aUS$271.8 million market by 2022 at a CAGR of approximately 11%.

The Pharmaceutical Ophthalmic Market

This constitutes the ophthalmic therapeutic drug market. Globalophthalmic drugs market size was valued at almost $30 billion,in 2016, and is expected to reach $42 billion by 2023, registeringa CAGR of 5.3% from 2017 to 2023.[8] 35% contribution comesfrom North America partly due to increase in geriatric populationthere. Ophthalmic drug's drivers globally include those usedto treat glaucoma, cataract, and retinal conditions: ARMD anddiabetic retinopathy.

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Narayanan Ophthalmic pharma market perspective

The retina and glaucoma market dominate the therapeuticglobal ophthalmology market with almost a 20% share each,while dry eye prescription market is under 5% with a highercomponent of OTC sale. According to the American Academyof Ophthalmology, 11 million people in the U.S. suffer from agerelatedmacular degeneration (AMD), while approximately 10%of them have wet AMD. Retinal disorders indication has registeredsignificant growth rate, (CAGR of 5.8% from 2017 to 2023) withdry AMD segment accounting for the highest share among all theretinal disorders in 2016.[8] There is a high prevalence of glaucomaworldwide and rise in transition toward the development ofcombination therapies for the treatment of glaucoma. Such trendsare contributing to the growth of the global retina market. Increasein investment by market players in emerging economies offerslucrative opportunities for market growth in near future.[8]

Introduction of novel ocular drug delivery is currently theglobal focus. Multicompartment drug delivery systems registeredthe highest CAGR of 8.0% with increase in the development ofnovel ocular drug delivery approaches including nanoparticles,noisome, and dendrimers.[8]

In India, the pharmaceutical ophthalmic market has grownfrom around 1400 crores INR in 2014 to 2200 crores INR in2018. Currently, this market is growing at a rate of 6.4% (2018).[9]

Glaucoma and tear substitutes (for dry eye) lead thepharmaceutical market in India (Figures 1 and 2 show the relativebreakup of the Indian ophthalmic drug market subsegments andtheir current growth, respectively).

By market share, the dry eye segment is the largest with methylcellulose-based (carboxymethyl cellulose and hydroxypropylmethylcellulose) tear substitutes and lubricants forming the bulkof this market along with other polyethylene glycol and polyvinylalcohol-based tear substitutes. Around 3-4% contributioncomes from topical cyclosporine, around 2% from hyaluronicacid-based lubricating drops and < 1% from topical rebamipideand Vitamin A. Branded generics constitute around two-third ofthis market with overall almost 200 brands.

The glaucoma segment is the fastest growing subsegment inthe ophthalmic pharmaceutical market. Value wise more than onethirdof this market is with prostaglandin analogs, with almost 25%of the glaucoma market value constituted by innovator brandedprostaglandin analogs. Another one-third of the market is with fixeddosecombinations, with brimonidine-timolol combination takingup 20% of the overall glaucoma market value. The rest is distributedevenly among beta-blockers, alpha-agonists, and carbonic anhydraseinhibitors. Overall, around 45% of market is with innovator brands,which is the highest for any ophthalmic submarket and the rest withbranded generics. The glaucoma market breaks up in India closelymirrors global glaucoma market trends.

The anti-infectives and their combinations with corticosteroidsform one-fourth of the ophthalmic pharmaceutical market, whichconsists predominantly of branded generics with a significantprescription contribution from physicians as well. Currently,moxifloxacin (45%), nepafenac (51%), and olopatadine (38%) arethe key player in the anti-infective, nonsteroidal anti-inflammatorydrugs, and antiallergic ophthalmic drugs submarkets, respectively.Among the plain steroids, loteprednol, fluorometholone, andprednisolone constitute 90% of this relatively small submarketwith loteprednol representing the growing market. The retinamarket is currently dominated by various antioxidant combinationsupplements which constitute almost 90% of the retinapharmaceutical submarket, with monoclonal antibodies taking upthe rest with a minor contribution from formulations like siliconoil. The other small submarkets (1% each) include saline/salts,mydriatics, and anesthetic drops, and other herbal preparations.[9]

Pharmaceutical ophthalmic market perspectives in Indiaand emerging trends
Figure 1: Percentage market share of ophthalmic drug segments inIndian market (2018)

Pharmaceutical ophthalmic market perspectives in Indiaand emerging trends
Figure 2: Percentage growth of ophthalmic subsegments in India

Future Prospects

More than three-fourths of the ophthalmic drug market are withbranded generics and this generic market will continue to expandin every subsegment in sync. with expected growth of the overallophthalmic pharmaceutical Indian market. The eye drop segmentof tear substitutes, anti-infectives with and without steroids, andsaline/salt preparations has a considerable component of OTCsale. Three ophthalmic segments are poised for introduction ofinnovator brands in the near future. Dry eye segment may showthe entry of drugs such as lifitegrast, lacritin, nasal tear stimulators,and sodium channel blockers as well as improvement informulation technology with nanomicellar formulations, mucuspenetration particle technology, and addressing meibomian glanddysfunction.[10-16] Glaucoma segment has already shown two newUSFDA approvals in Rho kinase inhibitors and latanoprostenebunod, with a third trabodenoson (adenosine A1 agonist) beingreevaluated.[17-19] The retina segment is likely to show DARPins(ankyrin derivatives), non-biodegradable long-term fluocinoloneelutingimplants, antiplatelet-derived growth factors, and numberof monoclonal antibody drugs in development.[20-22]

36 Clinical and Experimental Vision and Eye Research, January-June, Vol 1, 2018

Ophthalmic pharma market perspective Narayanan

This overview gives a glimpse of the current structure and growthtrend of the ophthalmic pharmaceutical market in India along withfuture prospects and development of innovative new drugs, as wellas innovations in formulations and delivery technology.

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