The acute ischemic stroke (AIS) market is about to experience growth across the eight major markets (the 8MM: US, France, Germany, Italy, Spain, UK, Japan, and China) from 2017 to 2027. The major barriers to the AIS market growth will be the availability of cheap and established anticoagulants such as warfarin, and the upcoming patent expiries of the branded non-vitamin K antagonist oral anticoagulants (NOACs) within 10 years. Despite this, market sales will increase across the 8MM due to the increasing incidence and prevalence of AIS as well as the anticipated launches of novel, presumably highly priced, neuroprotective drugs and stem cell therapies. China will experience the biggest increase in AIS patient population, according to GlobalData epidemiologists. As a result, China will experience the biggest market growth after the US, despite the lack of the new products launching in this market. GlobalData believes that the China AIS market holds a huge opportunity for drug companies pursuing development of drugs for post-stroke recovery.

AIS results from a complete blockage of a cerebral artery, leading to the death of brain cells and permanent damage. Current treatment of AIS centres around the restoration of blood flow to the brain by thrombolysis using Roche’s Activase (alteplase)—the only thrombolytic drug for AIS—or endovascular treatment to reverse ischemic stroke, or both in combination. After the acute event, antiplatelet, anticoagulant, statin, and antihypertensive drugs are used to prevent stroke recurrence.

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A substantial increase in the incidence and prevalence of AIS will be the sole driver of China’s AIS market growth in the next ten years. GlobalData foresees that the single greatest driver of the AIS market in China will be an increase in the incident and prevalent cases of AIS, likely due to China’s ageing population. China was the second biggest AIS market, after the US, in 2017, and will remain the second biggest market in 2027 due to its growing AIS population. The diagnosed incidence of AIS will increase from an estimated 2.3m stroke patients in 2017, to 3.6 m by 2027, while the prevalent cases of AIS will grow from 5.3m to 8.0m in China alone. The biggest barrier to growth of the China AIS market, however, will be the lack of new therapies launching in this market.

Figure 1 presents the global sales shares of AIS drugs in the 8MM in 2017.

Opportunity for stem cell therapy developers to penetrate the China AIS market

Despite the extended therapeutic time window for thrombolysis with Activase and implementation of endovascular treatment, many patients are still left with disabling neurological complications after a stroke. Poor neurological recovery following an AIS event is associated with great socioeconomic burden globally. Organised after-stroke care is particularly poor in China, which results in a high proportion of AIS patients losing their ability to live independently. According to China key opinion leaders interviewed by GlobalData, the biggest unmet need in China is improving after-stroke care, and therefore there is need for drugs that could reduce disabilities and improve stroke outcomes, especially for those with chronic stroke requiring rehabilitation. GlobalData believes that developers have a great opportunity in the China AIS market to commercialise new products designed to improve stroke outcomes.