Among the new agents entering the unipolar depression market over the next decade, Lundbeck/Takeda Pharmaceutical's Brintellix is set to achieve blockbuster status by 2022, according to new forecasts.

Brintellix is expected to be one of the most successful new agents in the unipolar depression markets of the US, France, Germany, Italy, Spain, the UK and Japan, because of its potential for positive effects on cognition and its reasonably tolerable side effect profile demonstrated to date, according to the research, from Decision Resources. The study expects Lundbeck and Takeda to position Brintellix (vortioxetine) as a first-line option for elderly patients with depression and as a second-line therapy in patients who fail a generic selective serotonin reuptake inhibitor (SSRI).

Major-market sales in the unipolar depression market are set to decline 30% during 2012-22 because of the entry of generic versions of the current blockbusters escitalopram, aripiprazole and duloxetine, as well as expanded generic competition for venlafaxine XR, it also forecasts.

The launch by 2022 of Brintellix and two other emerging antidepressants - Eli Lilly's edivoxetine and Forest Laboratories/Pierre Fabre's Fetzima (levomilnacipran extended-release capsules) - will be insufficient to counteract this decline; edivoxetine and Fetzima will together reach just under $1 billion in sales across the major markets by 2002, says Decision Resources.

Moreover, the atypical antipsychotic drug class will experience significant loss of sales in the unipolar depression market owing to continued generic erosion of key agents, causing major-market sales of this drug class to drop by half, to just under $1 billion in 2022. And the forecast launch of Otsuka/Lundbeck's brexipiprazole and the expanded use of Dainippon Sumitomo Pharma/Sunovion/Takeda's Latuda (lurasidone) across the major markets will only partially offset the forthcoming decline in drug class sales.

"In a highly generalised and fragmented market, in which SSRIs and serotonin and norepinephine reuptake inhibitors [SNRIs] are and will remain deeply-entrenched first-line agents, the uptake of emerging therapies among physicians will be highly dependent on their successful differentiation from currently-available SSRIs and SNRIs," says Alana Simorellis, senior business insights analyst at Decision Resources.

"An agent benefitting patients who fail to respond to current treatments, or one that treats residual symptoms of depression, represent opportunities for drug developers. An antidepressant or antipsychotic proven to be more effective in treatment-resistant patients would quickly gain physician acceptance and experience use, likely as part of an augmentation strategy," Dr Simorellis forecasts.