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 STROKE
1.1 Definition of stroke
1.1.1 Classification of stroke
1.1.1.1 Ischaemic stroke
1.1.1.2 Haemorrhagic stroke
1.1.1.3 Transient ischaemic attack
1.2 Diagnosis of stroke
1.3 Pathophysiology of stroke
1.4 Incidence and prevalence of hypertension
1.4.1 Special populations
1.4.1.1 Elderly
1.4.1.2 Sex
1.4.1.3 Race
1.5 The economic cost of hypertension
1.6 Risk factors for hypertension
1.6.1 Hypertension
1.6.2 Atherosclerosis and coronary heart disease
1.6.3 Atrial fibrillation
1.6.4 Diabetes
1.6.5 Cholesterol
1.6.6 Lifestyle factors
1.6.7 Other factors
1.7 Complications associated with stroke
1.7.1 Paralysis
1.7.2 Cognitive deficits
1.7.3 Language deficits
1.7.4 Emotional deficits
1.7.5 Pain
1.8 The management of stroke
1.8.1 Non-pharmacological management
1.8.1.1 Lifestyle adjustments in primary and secondary prevention
1.8.1.2 Rehabilitation
1.8.1.3 Surgical management
1.8.2 Pharmacological management
1.9 Conclusion

CHAPTER 2 MARKETED STROKE THERAPIES
2.1 Introduction
2.2 Drugs marketed for the prevention of stroke
2.2.1 HMG-CoA reductase inhibitors
2.2.1.1 Pravastatin
2.2.1.2 Simvastatin
2.2.2 Anticoagulants/antithrombotics
2.2.2.1 Heparin
2.2.2.2 Warfarin
2.2.3 Antiplatelets
2.2.3.1 Aspirin
2.2.3.2 Clopidogrel
2.2.3.3 Dipyridamole
2.2.3.4 Dipyridamole plus aspirin
2.2.3.5 Ticlopidine
2.3 Drugs marketed for the acute treatment of stroke
2.3.1 Anticoagulant/antithrombotic therapy
2.3.1.1 Argatroban
2.3.1.2 Nadroparin
2.3.2 Thrombolytic therapy
2.3.2.1 Alteplase
2.3.2.2 Monteplase
2.3.3 Neuroprotective agents
2.3.3.1 Citicoline
2.3.3.2 Fasudil
2.3.3.3 Nilvadipine
2.3.3.4 Nimodipine
2.3.3.5 Tirilazad mesylate
2.4 Conclusion


CHAPTER 3 STROKE THERAPIES IN DEVELOPMENT
3.1 Introduction
3.2 Anticoagualants/antithrombotics in development for stroke therapy
3.2.1 Ancrod
3.2.2 Danaparoid sodium
3.3 Antiplatelets in development for stroke therapy
3.3.1 Abciximab
3.3.2 Pamicogrel
3.3.3 Satigrel
3.3.4 YM-337
3.4 Thrombolytics in development for stroke therapy
3.4.1 Prourokinase
3.5 Neuroprotective agents in development for stroke therapy
3.5.1 Antioxidants and free radical scavengers
3.5.1.1 Edaravone
3.5.1.2 Nicaraven
3.5.1.3 EPC-K1
3.5.1.4 Nitrone-related therapeutics
3.5.2 Calcium channel antagonists
3.5.2.1 Watanidipine
3.5.2.2 Ziconotide
3.5.3 Inhibitors of toxic excitatory neurotransmitters
3.5.3.1 N-methyl-D-aspartate antagonists
3.5.3.2 (-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid antagonists
3.5.3.3 Inhibitors of glutamate release
3.5.3.4 Other neurotransmitter antagonists/agonists
3.5.4 Cellular growth and inflammatory response modulators
3.5.4.1 Trafermin
3.5.4.2 LeukArrest
3.5.4.3 LDP-01
3.5.4.4 Neutrophil inhibitory factor
3.5.4.5 sc5G1.1
3.5.5 Other neuroprotective targets
3.5.5.1 CPC-211
3.5.5.2 JTP-2942
3.5.5.3 ONO-2506
3.5.5.4 S-5920
3.5.5.5 TAK-044
3.5.5.6 TP20
3.5.5.7 Vinconate
3.6 Conclusion


REFERENCES


LIST OF TABLES
Table M.1 Average exchange rates against the US$, 1996-1998
Table 1.1 Drugs for treatment of acute ischaemic stroke
Table 1.2 Drugs for secondary prevention of stroke
Table 2.1 Anticoagulants/antithrombotics indicated for stroke
Table 2.2 Antiplatelets indicated for the prevention of stroke
Table 2.3 Antithrombotics used for the treatment of acute ischaemic stroke
Table 2.4 Neuroprotectors indicated for the treatment of acute stroke
Table 3.1 Investigational antioxidants and free radical scavengers in development
Table 3.2 Calcium channel antagonists in development
Table 3.3 NMDA antagonists in development
Table 3.4 AMPA antagonists in development
Table 3.5 Inhibitors of glutamate release in development
Table 3.6 Cellular growth and inflammatory response modulators in development
Table 3.7 Other neuroprotective agents in development

LIST OF FIGURES
Figure 1.1 Causes of ischaemic stroke
Figure 1.2 Haemorrhagic stroke
Figure 1.3 Prevalence of stroke in the 25-75 age group in the US, 1971-1994
Figure 1.4 Estimated prevalence of stroke by age and sex in the US, 1988-1994


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

EXECUTIVE SUMMARY
The consequences of a stroke can be devastating. Apart from the large number of fatalities associated with stroke, the disease is the leading cause of adult disability in the world with up to 30 million people left disabled by brain attacks each year.


Chapter 1 describes the different forms of stroke and provides an overview of the different treatment options available. This chapter will also summarise the main risk factors involved in stroke and highlight those groups most at risk from the suffering a cerebrovascular attack.


Chapter 2 provides an analysis of the therapeutic options available to treat this crippling disease. The medical treatment of ischaemic stroke has largely been inadequate and there is still a tremendous unmet need for an effective therapeutic option. The thrombolytic, alteplase, used with some success in the treatment of heart attacks, has provided an improved option but its narrow treatment window means that a large proportion of patients are still not accommodated for.


New agents in development may have the potential to extend the limited treatment window well beyond the current 3-hour period. Such agents include Abbott's prourokinase (Prolyse) and Knoll's ancrod (Viprinex) and these agents will be reviewed in Chapter 3.


Preventative treatment in stroke still revolves around the traditional medicines of warfarin and aspirin. The agents in development that play a role in protecting against a first stroke or a recurrent attack have not shown much improvement over the established options and, as such, may struggle to gain market acceptance.


The biggest disappointment in stroke therapy has been the failure to develop an effective neuroprotector to shield the brain from injury during a cerebrovascular attack. The majority of neuroprotective agents developed thus far have proved inconclusive and some may even be detrimental to the patient. Nevertheless, there are some promising agents in development and although the failures still outweigh the successes, a number of investigational drugs may yet offer a better alternative to the current choices.

© PJB Publications Ltd. 2000
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