Sales of drugs to treat chronic heart failure are set to soar, from around $2.9 billion in 2013 to $8.9 billion in 2023, according to new forecasts.

Growth in sales of CHF treatments in seven major markets – US, UK, France, Germany, Italy, Spain and Japan – over the period will be driven largely by the introduction of Novartis’ LCZ-696, a first-in-class dual angiotensin II receptor antagonist (AIIRA)/neprilysin inhibitor. With launch scheduled for second-half 2015, LCZ-696 could add nearly $4 billion in annual sales to the CHF market in 2023, according to the forecasts, from Decision Resources.

LCZ-696 has the potential to revolutionise the CHF treatment paradigm by seeking to displace the well-established first-line therapies -angiotensin-converting enzyme (ACE) inhibitors and AIIRAs. However, Novartis’ product will face a number of hurdles to its uptake, the biggest of which may be its expected high price compared to generically-available CHF agents, says the study.

“LCZ-696 has demonstrated the potential to disrupt the well-established CHF treatment algorithm following favourable results from the PARADIGM-HF study. This exciting new agent represents a step up from past and present agents in development for CHF in that it could replace the standard of care for many CHF patients,” comments Decision Resources group analyst Joseph Dwyer.

A variety of therapies offering an eclectic mix of mechanisms of action will also launch for CHF during the 10-year forecast period. These include Novartis’ Tekturna/Rasilez (aliskiren), Bayer’s finerenone (BAY-94-8862), Teva/Mesoblast’s CEP-41750, Celladon’s genetically-targeted enzyme replacement therapy Mydicar and Bayer’s Xarelto (rivaroxaban).  Collectively, these agents could contribute sales of nearly $2 billion across the seven markets in 2023, the report estimates.

Additionally, with commercialisation agreements now place with Amgen and Ono Pharmaceutical to develop and market Servier’s Procoralan (ivabradine) in the US and Japan, respectively, Decision Resources expects this product to become commercially available in these two markets during the forecast period.

It also examines prospects within the acute heart failure (AHF) market, which will see the launch of two novel biologic vasodilators, Novartis’ serelaxin and Cardiorentis’ ularitide during the period. Together, these two products could contribute more than $2.6 billion to the AHF market in 2023, it says.

Previous R&D efforts in the AHF segment have been plagued by high attrition rates, and this has resulted in a highly genericised market in which no new therapies have been launched since 2002, comments Dr Dwyer.  “Serelaxin and ularitide are poised to fulfil a number of unmet needs and have the potential to greatly expand this market,” he says.