Anti-fungal market: In High Gear

With growing awareness and understanding of fungal infections, India’s anti fungal market is slated to grow phenomenally in the years to come By Sachin Jagdale

Advances in medical technologies have made detection of fungal infections easier than ever before. Pharma companies also complemented to this change by launching drugs to treat these infections. India’s tropical environment is a breeding ground for varied types of fungi and hence provides a lot of opportunities to the pharma operators to keep the drug market flooded with various anti-fungal drugs. According to AIOCD Pharmasofttech AWACS data, total anti-fungal market across categories is pegged at Rs 1069 crores, growing at 26.9 per cent and 16.6 per cent on units.(See table on pg no. 13)

Growth drivers

Invasive procedures at hospitals also give rise to risk of fungal infections at an alarming rate. Therefore, the market for anti-fungal drugs have started considering these risk factors as well. “The anti-fungal drug market is driven by the improved understanding of the ICU patient’s risk factors to develop invasive fungal infections,” says Dr Somnath Datta, Business Unit Head – Critical Care Sales and Marketing, Mylan Pharmaceuticals He adds, “For decades, doctors taking care of immunocompromised patients understood the scourge of fungal infection in their patients such as hemato-oncological malignancy, transplant etc. Now, they are cognizant of the same even in patients with risk factors such as diabetes, old age, total parenteral nutrition (TPN) which are latent immunocompromised states. The other growth driver is the awareness about the myriad fungal infections that can affect the Indian patients and that the empirical or prophylaxis therapy with the standard anti-fungal drug may not suffice. The newer anti-fungals (anidulafungin etc.) have seen a robust growth in the last three to four years, so has been the resurgence of reserve drugs such as amphotericin B which is now being used for these difficult-to-treat fungal infections.”

Government’s role has also proved instrumental in driving anti-fungal drug market in India. Understanding the rising episodes of fungal infections in the country, the government employed various measures on its own including public private partnership (PPP). This development is largely responsible for propelling the market. While echoing Datta’s views, Sharad Dahatonde, General Manager-Biotechnology, Elder Pharmaceuticals, says that growing invasive techniques at the hospitals have indeed helped pharma operators from anti-fungal drug category grow. According to Dahatonde, conditions like AIDS compromise immunity of the patients and make them susceptible to fungal infections.

Dahatonde informs that Mycoses, which are fungal skin infections, are expected to provide a promising market for growth currently due to prevalence of numerous diabetes patients and, population’s changing lifestyle and environmental conditions.

The dermatological anti-fungal market is Rs 605 crores, whereas the anti-infectives fungal market is Rs 378 crores. Glenmark is the leader at Rs 183 crores followed by Macleods at Rs 122 crores and Mankind at Rs 83 crores. Panderm Plus is the biggest brand at Rs 122 crores followed by Candid at Rs 59 crores and Cancidas at Rs 35 crores (Source: AIOCD Pharmasofttech AWACS data.)

Physicians’ influence

Doctors and physicians also have an impact on the growth of the drug market. These physicians are spread across different categories. Datta informs, “Physicians across various specialties including critical care, microbiology, infectious disease etc. have helped raise awareness of fungal infection among the hospital patients. Numerous researchers including the HOD of PGIMER, Chandigarh, Dr Arunaloke Chakrabarti have collated and published India-specific data to help clinicians understand the prevalence of various fungal species that invade our ICUs. Plus, the MNC pharma companies have also helped to create awareness by numerous programmes involving case studies, inviting international speakers etc. This has helped in identification of species, better understanding of the resistance pattern and usage of right anti-fungals to manage the patient. Usage of Azoles, Echinocandins and Amphotericin B – all have increased henceforth improving the overall mortality and morbidity rates in such patients.”

Physicians’ prescriptions are among the biggest drivers of anti-fungal drug market. However, on the other hand, random administration of these medicines have given rise to drug-resistant varieties of fungi. This has again made pharma companies work on new drugs and launch them in the market.

Dahatonde says, “Physicians leave major impact on the anti-fungal drug market in India. There is need to bridge the gap between policy makers and health-care service providers to help the ailing population.”

AIOCD Pharmasofttech AWACS data suggests that Clotrimazole followed by a combination of Terbinafine, Clobetasol, Ofloxacin and Ornidazole are the biggest molecules in the market.

India-specific challenges

Medical advances have brought in enormous understanding regarding fungal infections, however, these technologies may not have reached many hospitals across the country. Moreover, in a country with more than one billion people, it is a big challenge to recognise and reach the potential infection carrier.

“The major challenge is the lack of diagnostic facilities for fungal infections. Most private and government hospitals have inadequate lab facilities for speciation of the fungus and assessing the resistance pattern. This leads to lower diagnosis rates which leads to lower treatment rates and false sense of security among ICU physicians that fungal infections are rare in their centres,” says Datta.

“The number of therapeutic options for the treatment of invasive fungal infections is quite limited in India as compared with those available to treat bacterial infections,” reveals Dahatonde.

There is also a demand-supply gap. Still a considerable chunk of population is deprived of necessary anti-fungal treatment. Dahatonde explains the situation, “Anti-fungal drug development has not kept pace with the clinical needs in India so far and the rate of anti-fungal drug discovery is unlikely to be sufficient for future demands. The number of patients at risk for fungal infections is increasing as immunomodulatory therapies continue to expand and our ability to support highly immunocompromised patients improves. Consequently, we are faced with the challenge of an expanding set of at-risk patients, increasing the prevalence of difficult-to-treat organisms, and a slow pace of new drug development.”

Deepali Chile, Chief Executive Officer, Brassica Pharma, also says that resistivity towards current anti-fungal drugs e.g acquired and intrinsic resistance in Aspergillus and Candida is currently a big challenge.

Though pharma companies in India sell drugs really cheap in the world, cost is still an issue for most of the population and this is again a hindrance in treating fungal infections. It is very necessary to make advanced diagnostic options available at affordable rates in tier two and three hospitals as well.

Future market drivers

India is the diabetic capital of the world. There are many other diseases like cancer, AIDS which are growing among the Indian population. Transplants and immunological complications are common with patients suffering from these diseases. This scenario is going to drive anti-fungal drug market in future. Also, on the economic front, Indian population is doing good and most of the Indian population is in a position to spend money on drugs and advanced diagnostic methods.

Datta says, “The major growth drivers are primarily macroeconomics and population dynamics. As more patients undergo transplant surgeries, the incidence of fungal sepsis will increase. Also, with higher age-wise longevity, more disposable income and better diagnostic facilities (also linked to macroeconomics), more patients will get diagnosed with fungal infection at the right time and would get treated in the right way to improve survivability. With large scale prevalence data specific for India coming up, doctors will be able to choose the medicines better and that should lower the cost of therapy as well.”

According to Chile, Echinocandin and pneumocandins are the new class of anti-fungal drugs which would serve as main targets of the future research.

Dahatonde signs off saying, “A growing and ageing population, increasing incidence of fungal conditions, the development and approval of new products, additional indications and formulations, and increased Indian market penetration will be driving factors for the market over the next decade. The market can expect to see a continued demand for products; however, the low cost of generic products will generate added pressure for marketers of brand products. Generic competition will remain highly competitive.”

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