Scrip's Complete Guide to Cardiovascular Diseases


Therapeutic


NEW
Providing in-depth information on all the major cardiovascular disease (CVD) areas of hypertension, coronary heart disease, arrhythmia, congestive heart failure and stroke, this extensive report includes:


* R&D information for over 200 drugs currently in development
* Market potential estimates for new and emerging therapies
* Current market figures and sales forecasts to 2002
* Profiles of 19 major players in the CVD treatment market


Scrip's Complete Guide to Cardiovascular Diseases provides you with a comprehensive overview of the CVD market. Volume 1 of the report details the most advanced clinical understanding of CVD. By providing you with the latest market data, and commentary on trends and influences that will shape the CVD drug market, this report allows you to gain a complete understanding of both current and future market status.


Volumes 2-5 cover each disease area separately. Each includes an introduction to the disease area and the latest understanding of the disease process, an in-depth evaluation of drugs on the market and their performance, opportunities for new products and a detailed analysis of products in clinical development. Each volume also has up-to-date trial data and tabulated information on compounds in development, from preclinical to registered.


PUBLISHED: November 1999
REF: BS1030E
PAGES: 500+
PRICE: Complete six-volume set �990/$1,995/�238,000


CONTENTS
LIST OF TABLES
LIST OF FIGURES
EXECUTIVE SUMMARY
METHODOLOGY
ABBREVIATIONS
CLINICAL TRIAL ACRONYMS

 
CHAPTER 1 INTRODUCTION TO ARRHYTHMIA
1.1 Definition of arrhythmia
1.1.1 Classification of arrhythmia
1.1.1.1 Ventricular arrhythmias
1.1.1.2 Atrial arrhythmias
1.2 Diagnosis of arrhythmia
1.2.1 Electrocardiograms
1.2.2 Electrophysiological studies
1.3 Pathophysiology of arrhythmia
1.4 Incidence and prevalence of arrhythmia
1.4.1 Special populations
1.4.1.1 The elderly
1.4.1.2 Sex
1.4.1.3 Race
1.5 The economic cost of arrhythmia
1.6 Risk factors for arrhythmia
1.6.1 Atherosclerosis and coronary heart disease
1.6.2 Hypertension
1.6.3 Congestive heart failure
1.6.4 Long QT syndromes
1.6.5 Other factors
1.7 Complications associated with arrhythmia
1.7.1 Sudden cardiac death
1.7.2 Stroke
1.8 The management of arrhythmia
1.8.1 Non-pharmacological management
1.8.1.1 Implantable devices
1.8.1.2 Intervention techniques
1.8.2 Pharmacological management
1.9 Conclusion

CHAPTER 2 ANTIARRHYTHMIC DRUGS ON THE MARKET
2.1 Introduction
2.2 Class I antiarrhythmics
2.2.1 Class IA antiarrhythmic agents
2.2.1.1 Cibenzoline
2.2.1.2 Disopyramide
2.2.1.3 Pirmenol
2.2.1.4 Procainamide
2.2.1.5 Quinidine
2.2.2 Class IB antiarrhythmic agents
2.2.2.1 Lignocaine
2.2.2.2 Mexiletine
2.2.2.3 Phenytoin
2.2.2.4 Tocainide
2.2.3 Class IC antiarrhythmic agents
2.2.3.1 Flecainide
2.2.3.2 Lorcainide
2.2.3.3 Moricizine
2.2.3.4 Pilsicainide
2.2.3.5 Propafenone
2.3 Class II antiarrhythmics
2.3.1 Cardioselective beta-blockers
2.3.1.1 Acebutolol
2.3.1.2 Atenolol
2.3.1.3 Esmolol
2.3.1.4 Metoprolol
2.3.2 Non-selective beta-blockers
2.3.2.1 Nadolol
2.3.2.2 Oxprenolol
2.3.2.3 Propranolol
2.3.2.4 Sotalol
2.4 Class III antiarrhythmics
2.4.1 Amiodarone
2.4.2 Bretylium
2.4.3 Bunaftine
2.4.4 Ibutilide fumarate
2.5 Class IV antiarrhythmics
2.6 Unclassified antiarrhythmics
2.6.1 Adenosine
2.6.2 Digoxin
2.7 Conclusion


CHAPTER 3 ANTIARRHYTHMIC DRUGS IN DEVELOPMENT
3.1 Introduction
3.2 Class I antiarrhythmic agents in development
3.2.1 Milacainide
3.2.2 RSD-921
3.3 Class II antiarrhythmic agents in development
3.3.1 Landiolol
3.3.2 UK-1745
3.4 Class III antiarrhythmic agents in development
3.4.1 Azimilide
3.4.2 Dofetilide
3.4.3 Dronedarone
3.4.4 E-047/1
3.4.5 EGIS-7229
3.4.6 HMR-1883
3.4.7 KCB-328
3.4.8 Nifekalant
3.4.9 SB-237376
3.4.10 Trecetilide
3.5 Class IV antiarrhythmic agents in development
3.5.1 Verapamil
3.5.2 Kurtoxin-1
3.6 Unclassified antiarrhythmic agents in development
3.6.1 Adenosine agonists
3.6.1.1 CVT-510
3.6.1.2 CVT-609 and CVT-429
3.6.1.3 DTI-0009
3.6.2 Sodium/hydrogen exchange inhibitors
3.6.2.1 Cariporide
3.6.2.2 KB-R9032
3.6.3 Alpha-1A antagonists
3.6.3.1 Alpha-1A antagonists
3.6.3.2 LY-353433
3.6.4 AM-524 and digoxin-like cardiostimulants
3.6.5 KB-130015
3.6.6 Mildronate
3.6.7 Pharmaprojects No 6176
3.7 Conclusion


REFERENCES


LIST OF TABLES
Table M.1 Average exchange rates against the US$, 1996-1998
Table 1.1 Antiarrhythmic drugs classified by their mode of action
Table 2.1 Class IA antiarrhythmic agents currently on the market
Table 2.2 Class IB antiarrhythmic agents currently on the market
Table 2.3 Class IC antiarrhythmic agents currently on the market
Table 2.4 Beta-blockers indicated for arrhythmia
Table 2.5 Class III antiarrhythmics currently on the market
Table 3.1 Class I antiarrhythmic agents in development
Table 3.2 Class II antiarrhythmic agents in development
Table 3.3 Class III antiarrhythmic agents in development
Table 3.4 Class IV antiarrhythmic agents in development
Table 3.5 Unclassified antiarrhythmic agents in development

LIST OF FIGURES
Figure 1.1 Prevalence of atrial fibrillation, 1968-1989



This volume, Arrhythmia, is part of a series forming Scrip's Complete Guide to Cardiovascular Diseases. The other volumes in this series are:


EXECUTIVE SUMMARY
Arrhythmia is a condition that affects over 4.3 million people in the US and it is the most common form of sudden cardiac death. Although this sector is the smallest in terms of sales in the cardiovascular market, it is still important in its own right.


Chapter 1 gives an overview of arrhythmia, detailing the different forms of the condition. Atrial fibrillation is the most common type of arrhythmia and its prevalence is rising due to the increasing number of post-myocardial infarction survivors; atrial fibrillation is a major risk factor for stroke. Chapter 1 also reviews all the treatment options available for arrhythmia, including interventional procedures.


The antiarrhythmic market has been beset by problems in recent times. Chapter 2 reviews the status of the antiarrhythmic market, focusing on the difficulties faced by marketed drugs. Class I drugs were initially used as first-line agents in antiarrhythmic therapy. However, recent trials have highlighted the proarrhythmic properties of these agents that can actually increase mortality. The pharmacological management of arrhythmia is also under intense pressure from the increasing popularity of implantable devices. Nevertheless, whilst an implantable cardioverter defibrillator (ICD) is effective in preventing sudden cardiac death in patients with sustained ventricular tachycardia and fibrillation, the management of atrial fibrillation/flutter is more difficult to control with implantable devices. Furthermore, not all patients are suitable candidates for ICD therapy. Only beta-blockers currently appear to have a consistent benefit on mortality rates in arrhythmias, but Class III agents such as amiodarone have proved beneficial and this approach may be the future direction of antiarrhythmic drugs.


The development of agents specifically for patients with atrial fibrillation/flutter is still an active research area, particularly because these patients are not ideal candidates for ICD treatment. Antiarrhythmic drug development has largely focused on Class III agents as drugs in this class appear to have a better safety profile than Class I antiarrhythmics. In addition, new approaches are under investigation in an attempt to provide safer and more effective alternatives to the present options. Investigational agents for arrhythmias are reviewed in Chapter 3.

© PJB Publications Ltd. 2000
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