TWINRIX (PROPHYLACTIC HEPATITIS B VIRUS VACCINES ... · analysis of immunization policy at the...

REFERENCE CODE GDHC341DFR | PUBLICAT ION DATE JANUARY 2014

TWINRIX (PROPHYLACTIC HEPATITIS B VIRUS VACCINES) - FORECAST AND MARKET ANALYSIS TO

2022

Twinrix (Prophylactic Hepatitis B Virus Vaccines) - Forecast and Market Analysis to 2022 2 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.

TWINRIX (PROPHYLACTIC HEPATITIS B VIRUS VACCINES) - FORECAST AND MARKET ANALYSIS TO 2022

Executive Summary

The table below provides a summary of the key

metrics for Twinrix in the 8MM Prophylactic HBV

vaccines markets during the forecast period from

2012–2022.

Twinrix: Key Metrics in the 8MM Prophylactic HBV Vaccines Markets, 2012–2022

2012 Market Sales

US $20.0m

5EU $11.2m

Japan N/A

Canada $6.0m

Total $37.2m

Key Events (2012–2022) Level of Impact

Dynavax Technology’s Heplisav launch in 2018 ↓

2022 Market Sales

US $7.2m

5EU $5.4m

Japan N/A

Canada $6.1m

Global* $18.7m Source: GlobalData 8MM= US, France, Germany, Italy, Spain, UK, Japan and Canada 5EU = France, Germany, Italy, Spain and UK N/A: not available

Sales of Twinrix in the HBV Vaccines Market, 2012–2022

The combined sales of Twinrix were estimated at

$37.2 million in 2012. By 2022, we project Twinrix

sales to fall to $18.7 million, with a negative

Compound Annual Growth Rate (CAGR) of 6.6%

over the course of the decade. These estimates

cover the sales in the eight countries included in

this report: the US, France, Germany, Italy, Spain,

the UK, Japan and Canada.

Key factors contributing to sales of Twinrix will

include:

Twinrix is the only marketed vaccine that

protects its recipients against both HAV and

HBV infections, which makes it the preferred

choice for vaccinating patients that require

protection from both diseases.

The yeast-derived, recombinant HBsAg

antigen makes accidental infection impossible

and thus eliminates the HIV transmission

concerns associated with the plasma-derived,

first-generation HBV vaccines. Physicians are

comfortable with Twinrix’s strong safety profile

and clinical performance.

In Canada, Twinrix is recommended for routine

immunization of preteens in multiple provinces,

which guarantees it market share in parts of

Canada for the foreseeable future.

Despite these drivers, the major barriers affecting

the sales of Twinrix will include:

Twinrix faces a formidable threat in the adult

vaccine market from Dynavax Technologies’

pipeline candidate Heplisav, as this vaccine

has shown superior immunogenicity in adults

and only requires two doses for protection in

most patients.



Executive Summary

Success of the infant immunization programs

could negatively impact the adult vaccine

market, as aging children may not need to be

revaccinated. Like other HBV vaccines, Twinrix

will be threatened by a decline in adults eligible

for vaccination.

The figure below illustrates the global Twinrix sales

by region during the forecast period.

Sales for Twinrix by Region, 2012–2022

53.8%

30%

16.2%

2012Total:$37.2m

US

5EU

Canada

38.7%

28.6%

32.6%

2022Total:$18.7m

Source: GlobalData

What Do Physicians Think?

The KOLs interviewed for this report shared their

expert insight into the HBV vaccines market. These

KOLs revealed that, while physicians are relatively

happy with the performance of the currently

marketed vaccines, they realize that there are still

glaring weaknesses in the treatment algorithm that

must be addressed. They cite increased vaccine

immunogenicity in adults as the most important

clinical unmet need, and also reveal the need for

improved dosing regimens, physician education,

and adult immunization strategies. According to the

KOLs, combination vaccines are also

advantageous for improving vaccination coverage

in the pediatric market. Ultimately, KOLs thought

that open dialogue between vaccine manufacturers

and policymakers is necessary for a vaccine’s

commercial success in the HBV vaccine market.

“Yes, I’m sure that physicians need to be better

educated on how to advise their patients about

immunization.”

OUS key opinion leader, November 2013

“A pediatric combination vaccine is more likely to

increase vaccine uptake than several vaccines

administered separately.”


“I think an ongoing dialogue between policymakers

and manufacturers, before vaccines are actually

launched, would be beneficial.”

OUS key opinion leader, October 2013



Executive Summary

“There is a lack of compliance in adults because

the series is extended over six months, so it may

be difficult to get patients to follow up...the lack of

compliance originates from the fact that we cannot

get an immune response in less than three doses.”

US key opinion leader, November 2013

“Selectively targeting subgroups within the

population has been shown repeatedly for different

vaccines to be a very ineffective [immunization]

strategy. Doctors and their office staff seemingly

have a very hard time in doing that. I mean that’s

just a fact that’s been demonstrated time and time

again.”


“I think there will be a growing trend towards the

use of combination vaccines.”

US key opinion leader, September 2013

“A key barrier to increasing vaccine coverage in

the adult population is lack of awareness on the

part of patients and physicians.”


“The available hepatitis B vaccines are incredibly

safe vaccines, and they are very effective. They

are not ideal, there are improvements that we

would like to make, and there are also substantial

enhancements of hepatitis B immunization

programs that are waiting to be undertaken.”


“The currently available hepatitis B

vaccines…require three doses. It would be great to

have a vaccine that only requires two doses. I

guess it’s unreasonable to hope for a vaccine that

only requires one [dose], but two doses would be

better.”


“To exploit opportunities, vaccine manufacturers

should produce better vaccines, vaccines that have

few side effects and are able to raise antibodies

levels higher… Companies should also be

investigating more efficient and cheaper vaccines

for development.”


“I think the number one unmet need is the

seroconversion problem… I would really like a

vaccine that induces seroconversion in nearly

everybody, if possible everyone… I would like a

vaccine that would induce in everyone more than

100mIU/mL HBs antibodies.”

OUS key opinion leader, October 2013



Table of Contents

1 Table of Contents

1 Table of Contents ....................................................................................................................... 5

1.1 List of Tables ...................................................................................................................... 7

1.2 List of Figures ..................................................................................................................... 7

2 Introduction ................................................................................................................................. 8

2.1 Catalyst ............................................................................................................................... 8

2.2 Related Reports .................................................................................................................. 9

2.3 Upcoming Related Reports ............................................................................................... 11

3 Disease Overview ..................................................................................................................... 12

3.1 Overview ........................................................................................................................... 12

3.2 Etiology and Pathophysiology ........................................................................................... 13

3.2.1 Etiology ......................................................................................................................... 13

3.2.2 Pathophysiology ............................................................................................................ 16

3.3 Symptoms ......................................................................................................................... 18

3.4 Prognosis .......................................................................................................................... 20

4 Vaccination Recommendations and Coverage Rates ............................................................... 21

4.1 Overview ........................................................................................................................... 21

5 Competitive Assessment .......................................................................................................... 25

5.1 Overview ........................................................................................................................... 25

5.2 Strategic Competitor Assessment ..................................................................................... 25

6 Twinrix ...................................................................................................................................... 28

6.1 Overview ........................................................................................................................... 28



Table of Contents

6.2 Immunogenicity ................................................................................................................. 29

6.3 Safety ............................................................................................................................... 31

6.4 SWOT Analysis ................................................................................................................. 31

6.5 Forecast ............................................................................................................................ 32

7 Appendix................................................................................................................................... 34

7.1 Bibliography ...................................................................................................................... 34

7.2 Abbreviations .................................................................................................................... 49

7.3 Methodology ..................................................................................................................... 52

7.4 Forecasting Methodology .................................................................................................. 52

7.4.1 Patient Populations Targeted for Vaccination ................................................................ 53

7.4.2 Vaccination Coverage Rates ......................................................................................... 56

7.4.3 Vaccinated Patients....................................................................................................... 57

7.4.4 Regulatory Approval vs. Advisory Committee Recommendation ................................... 57

7.4.5 General Pricing Assumptions ........................................................................................ 58

7.4.6 Individual Vaccine Assumptions .................................................................................... 59

7.5 Physicians and Specialists Included in this Study ............................................................. 60

7.5.1 Interviews of Key Opinion Leaders (KOLs) .................................................................... 61

7.5.2 Online Survey of High-Prescribing Physicians (non-KOLs)............................................ 63

7.6 About the Authors ............................................................................................................. 64

7.6.1 Analyst .......................................................................................................................... 64

7.6.2 Therapy Area Director ................................................................................................... 64

7.6.3 Global Head of Healthcare ............................................................................................ 65

7.7 About GlobalData .............................................................................................................. 66



Table of Contents

7.8 Disclaimer ......................................................................................................................... 66

1.1 List of Tables

Table 1: Modes of HBV Transmission .......................................................................................................... 17

Table 2: HBV Serological Markers and Test Interpretations ......................................................................... 18

Table 3: Symptoms of HBV Infection ........................................................................................................... 19

Table 4: HBV Vaccination Advisory Committees by Country ........................................................................ 22

Table 5: HBV Immunization Recommendations by Country ......................................................................... 23

Table 6: Targeted Age Group(s) for Routine Immunization and Most Administered HBV

Vaccines by Country in the Global Markets, 2014 ........................................................................... 24

Table 7: Leading Vaccines for HBV, 2014 .................................................................................................... 27

Table 8: Product Profile – Twinrix ................................................................................................................ 29

Table 9: Immunogenicity Profile – Twinrix .................................................................................................... 30

Table 10: Safety Profile – Twinrix ................................................................................................................... 31

Table 11: Twinrix SWOT Analysis, 2014 ........................................................................................................ 32

Table 12: Global Sales Forecasts ($m) for Twinrix, 2012–2022 ...................................................................... 33

Table 13: Patient Population(s) Targeted for HBV Vaccination in the Pediatric Market, by

Country .......................................................................................................................................... 54

Table 14: Patient Population(s) Targeted for HBV Vaccination in the Adult Market, by

Country .......................................................................................................................................... 55

Table 15: High-Prescribing Physicians (non-KOLs) Surveyed, by Country ...................................................... 63

1.2 List of Figures

Figure 1: HBV Structure and the Recombinant Vaccine Development Process .............................................. 14



Introduction

2 Introduction

2.1 Catalyst

The global (7MM and Canada) prophylactic hepatitis B virus (HBV) vaccine market has seen

moderate growth over the last several years, primarily due to the effectiveness of routine childhood

immunization programs and the strong clinical performance of currently marketed vaccines, such

as GSK’s Engerix-B, Pediarix/Infanrix Hexa, and Merck’s Recombivax HB, in these targeted

populations. Despite this success, opportunities still exist for improving the treatment algorithm.

The growing popularity of combination vaccines, along with the push for vaccines that achieve

higher seroconversion in non-responders, will serve to stimulate modest growth in the marketplace

over the forecast period from 2012–2022. GlobalData expects the following key factors to

contribute to the evolution of the prophylactic HBV vaccine market over the next decade:

The maintenance and/or increase of routine HBV vaccination coverage rates in the 7MM and

Canada will be essential to the commercial success of these vaccines, as widespread uptake

outside of official recommendations is unlikely. GlobalData believes that country-specific

immunization recommendations and policy implementation will be an essential metric for

determining future vaccine uptake. Our report provides a detailed, primary research-driven

analysis of immunization policy at the country level.

Vaccines that more effectively protect traditional non-responders, such as patients with chronic

kidney disease (CKD) and diabetes mellitus, have the potential to address an area of high

unmet need while simultaneously exploiting a largely untapped segment of the HBV vaccine

market. For example, Dynavax’s Heplisav has showed encouraging results in Phase III clinical

studies in the US. Key opinion leaders (KOLs) have indicated to GlobalData that, despite

superior clinical performance, the success of vaccines targeting these specific adult

populations will depend upon a drastic improvement in current coverage rates.

A growing preference for pediatric combination vaccines, particularly in the 5EU, is expected to

drive stiff competition between GSK’s Infanrix Hexa and Sanofi Pasteur MSD’s Hexyon.

Vaccine manufacturers will focus much effort on emphasizing the convenience and cost-

effectiveness of combination vaccines, but their eventual use will depend heavily on how well

they fit into country-specific vaccination schedules. Our report includes a thorough competitive



Introduction

assessment of marketed and late-stage pipeline vaccines in the 7MM and Canada, which

takes into account both clinical and commercial positioning.

GlobalData anticipates that vaccine manufacturers will face an uphill battle in countries that do

not currently recommend routine vaccination against HBV, such as the UK and Japan. Despite

pressure from patient advocacy and pro-immunization groups, KOLs have indicated that short-

term change to immunization policy appears unlikely. Firms interested in accessing these

markets may only target specific at-risk patient populations for the foreseeable future.

2.2 Related Reports

GlobalData (2013). PharmaPoint: HIV Therapeutics – Global Drug Forecast and Market

Analysis to 2022: Event-Driven Update, March, 2013, GDHC41PIDR

GlobalData (2013). PharmaFocus: Vaccine Adjuvants in Infectious Disease, March, 2013,

GDHC001PFR

GlobalData (2013). PharmaPoint: Pediatric Respiratory Syncytial Virus Prophylactics – United

States Drug Forecast and Market Analysis to 2022, April, 2013, GDHC102PIDR

GlobalData (2013). PharmaPoint: HCV Therapeutics – Global Drug Forecast and Market

Analysis to 2022, May, 2013, GDHC42PIDR

GlobalData (2013). PharmaPoint: Dermatophytic Onychomycosis – United States Drug

Forecast and Market Analysis to 2022, June, 2013, GDHC101PIDR

GlobalData (2013). PharmaPoint: Meningococcal Vaccines – Global Drug Forecast and Market

Analysis to 2022, June 2013, GDHC51PIDR

GlobalData (2013). PharmaFocus: Market Access Strategies for Antibiotics Targeting

Multidrug-Resistant Gram-Negative Bacteria, August 2013, GDHC004PFR

GlobalData (2013). PharmaFocus: HIV – R&D Strategies Towards Cure and Prevention,

August 2013, GDHC003PFR

GlobalData (2013). PharmaPoint: Meningococcal Vaccines – Global Drug Forecast and Market

Analysis to 2022: Event-Driven Update, August 2013, GDHC61PIDR

GlobalData (2013). PharmaPoint: Seasonal Influenza Vaccines – Global Drug Forecast and

Market Analysis to 2022: Event-Driven Update, September 2013, GDHC67PIDR



Introduction

GlobalData (2014). PharmaPoint: Prophylactic Hepatitis B Virus Vaccines – Global Drug

Forecast and Market Analysis to 2022: January 2014, GDHC68PIDR

GlobalData (2014). Ambirix (Prophylactic Hepatitis B Virus Vaccines) – Forecast and Market

Analysis to 2022, January 2014, GDHC331DFR

GlobalData (2014). Bimmugen (Prophylactic Hepatitis B Virus Vaccines) – Forecast and

Market Analysis to 2022, January 2014, GDHC332DFR

GlobalData (2014). Comvax (Prophylactic Hepatitis B Virus Vaccines) – Forecast and Market


GlobalData (2014). Engerix-B (Prophylactic Hepatitis B Virus Vaccines) – Forecast and Market


GlobalData (2014). Fendrix (Prophylactic Hepatitis B Virus Vaccines) – Forecast and Market


GlobalData (2014). Hexyon (Prophylactic Hepatitis B Virus Vaccines) – Forecast and Market


GlobalData (2014). Infanrix Hexa (Prophylactic Hepatitis B Virus Vaccines) – Forecast and


GlobalData (2014). Pediarix (Prophylactic Hepatitis B Virus Vaccines) – Forecast and Market


GlobalData (2014). Recombivax HB (Prophylactic Hepatitis B Virus Vaccines) – Forecast and


GlobalData (2014). Heplisav (Prophylactic Hepatitis B Virus Vaccines) – Forecast and Market


GlobalData (2014). Prophylactic Hepatitis B Virus Vaccines – US Drug Forecast and Market

Analysis to 2022, January 2014, GDHC214CFR

GlobalData (2014). Prophylactic Hepatitis B Virus Vaccines – 5EU Drug Forecast and Market




Introduction

GlobalData (2014). Prophylactic Hepatitis B Virus Vaccines – Japan Drug Forecast and Market


GlobalData (2014). Prophylactic Hepatitis B Virus Vaccines – Canada Drug Forecast and

Market Analysis to 2022, January 2014, GDHC217CFR

GlobalData (2014). Prophylactic Hepatitis B Virus Vaccines – Current and Future Players,

January 2014, GDHC1028FPR

2.3 Upcoming Related Reports

GlobalData (2014). PharmaPoint: Asthma Therapeutics – Global Drug Forecast and Market

Analysis to 2022, April 2014, GDHC75PIDR.

GlobalData (2014). PharmaPoint: Prophylactic HPV Vaccines – Global Drug Forecast and

Market Analysis to 2022, March 2014, GDHC84PIDR.


Appendix


7.7 About GlobalData

GlobalData is a leading global provider of business intelligence in the Healthcare industry.

GlobalData provides its clients with up-to-date information and analysis on the latest developments

in drug research, disease analysis, and clinical research and development. Our integrated business

intelligence solutions include a range of interactive online databases, analytical tools, reports and

forecasts. Our analysis is supported by a 24/7 client support and analyst team.

GlobalData has offices in New York, Boston, San Francisco, London, India and Singapore.

7.8 Disclaimer

All Rights Reserved.

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any

form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior

permission of the publisher, GlobalData.

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