The metabolic syndrome market looks set to nearly double over the next few years, leaping from $9.5 billion in 2004 to just shy of $18 billion in 2014, according to a report by market research analysts Decision Resources.

The new Pharmacor report - Metabolic Syndrome - says that market growth will be led by Anglo-Swedsish drugmaker Sanofi-Aventis' Acomplia (rimonabant) and US drug giant Pfizer's fixed-dose Lipitor (atorvastatin) and torcetrapib combination. In 2014, Acomplia and the Pfizer’s combo will pull in over $3 billion in sales, collectively swallowing 17% of the total market to treat metabolic syndrome.

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases such as stroke and type 2 diabetes. The battle for new, effective therapies to treat metabolic syndrome, a condition characterized by a group of metabolic risk factors in one person such as obesity, high blood pressure, insulin resistance/intolerance and blood fat disorders, is hotting up, but both of these products are yet to make it to market.

Sanofi-Aventis has recently pushed back the expected launch date for Acomplia to the second half of the year, after receiving an approvable letter for from the US Food and Drug Administration. Crucially, the group has confirmed that the FDA has not asked for an additional clinical trial to support approval of Acomplia in obesity, but another will be needed to support its approval in smoking cessation, an indication rejected by the agency outright.

Meanwhile, the future of Pfizer’s offering is also unclear. Reports recently emerged that the combination could face another two to three years of clinical trials, and the company is still undecided as whether to offer torcetrapib as a standalone therapy as well as in combination with Lipitor, after doctors voiced concerns over being pushed into choosing the Lipitor combo over rival cholesterol-lowering compounds, including Merck & Co's Zocor (simvastatin).

Pfizer is investing some $800 million in the Phase III programme for Lipitor/torcetrapib as part of its bid to reach the market ahead of rivals also battling to develop a drug with a dual action on both low-density and high-density lipoprotein cholesterol, and investors will be banking on Pfizer getting its product approved before Lipitor - an $11 billion drug - loses its patent protection in 2011.

The DR report also highlights the urgent need for a common definition of metabolic syndrome. “While we expect this market to grow substantially over the next decade, the achievement of a consensus definition of metabolic syndrome will have broad implications for the future of the market,” remarked DR analyst Donny Wong. “As the medical community continues to debate the different criteria that define metabolic syndrome, the recent release of similar definitions from the International Diabetes Federation and the American Heart Association marks a key milestone in the growing consensus among physicians.”