Ascites market to enlarge vigorously due to the rise in patient population, product availability, and expected launch of emerging therapies; will boost Ascites treatment market.
LAS VEGAS, April 13, 2021 /PRNewswire/ -- DelveInsight's "Ascites Market" report provides a thorough comprehension of the Ascites, historical and forecasted epidemiology, and the Ascites market trends in the 7MM [the United States, EU5 (Germany, Spain, Italy, France, and United Kingdom) and Japan]. The Ascites market report also proffers an analysis of the current Ascites treatment algorithm/practice, market drivers, market barriers, and unmet medical needs.
Ascites is a condition in which fluid collects in spaces within the abdomen. The disease is common in patients with cirrhosis and usually develops when the liver is beginning to fail. The elevation of the pressure in the veins that run through the liver and a decrease in liver function due to the liver's scarring result in the fluid build-up.
Hepatic cirrhosis accounts for up to 80% of Ascites cases, and malignancies account for approximately 10%. The other types of ascites are categorised as cardiogenic, nephrogenic, infectious, and miscellaneous.
According to DelveInsight's analysts, the total cases of Ascites due to cirrhosis were 240,730 cases in the 7MM in 2020. These cases are expected to increase during the study period of 2018–2030.
The principles behind the treatment of Ascites due to cirrhosis include diuretics, paracentesis, insertion of a transjugular intrahepatic portosystemic shunt (TIPS), and managing complications to Ascites such as spontaneous bacterial peritonitis (SBP). Mild and moderate Ascites due to liver cirrhosis can be treated with dietary sodium restriction, fluid restriction, use of diuretics, and use of therapeutic paracentesis.
Sodium restriction and diuretics are the mainstays of treatment for Ascites patients due to portal hypertension. Still, patients with low Serum Ascites Albumin Gradient (SAAG) Ascites do not respond well to these measures, except those with nephrotic syndrome.
Most often, patients will require water pills for Ascites treatment. Majorly used water pills are spironolactone (Aldactone) and/or furosemide (Lasix), and their dosages are appropriately adjusted. These water pills can cause blood electrolytes problems, and close monitoring by blood tests may be required. For patients unable to tolerate spironolactone due to painful gynecomastia, amiloride can be substituted, although it has a lower natriuretic effect than spironolactone. Eplerenone is a newer aldosterone antagonist used for heart failure treatment and is not associated with gynecomastia but has not been extensively researched yet to manage Ascites. Hydrochlorothiazide, in combination with furosemide, is not recommended due to combined hypokalemia. Torsemide and bumetanide have also been utilised in combination with spironolactone in the Ascites management, but they have not shown superiority over furosemide.
Among patients with cirrhosis and ascites, around 10-20% will develop refractory ascites. Once refractory ascites develop, one-year mortality is approximately 50%. Options for treatment include optimising medical management, serial large-volume paracentesis, transjugular intrahepatic portosystemic shunt (TIPS), peritoneovenous shunt, and liver transplantation.
Propranolol has shown to be associated with decreased survival in the setting of refractory ascites, and discontinuation should be considered. Oral Midodrine, an agent used to treat hypotension, increased mean arterial pressure, and improved survival in a pilot study in cirrhotic patients with refractory or recurrent ascites.
Liver transplantation is the ultimate treatment for cirrhosis and cirrhotic ascites as the refractory ascites portends a particularly poor prognosis.
The current Ascites market has a high unmet need for approved and efficacious therapies. The treatment options for Ascites patients are limited and with very few therapies in the pipeline.
Increasing patient population - The rise in the patient population of underlying conditions of Ascites such as liver cirrhosis, alcoholism, kidney or heart failure, malignancy, and others might contribute to an increase in the Ascites patient population.
Emerging therapies in the pipeline - Limited approved, and emerging therapies in the pipeline offer an excellent opportunity for the investment and development of novel therapies.
Unmet needs - Most of the therapies are developed to be administered frequently. Hence medications with better safety, effectiveness, and low treatment duration are the current unmet need of the Ascites market.
Rising awareness - The increasing healthcare activities and campaigns regarding the necessity to address ascites are aiding the market.
Complications associated with ascites - The probability of occurrence of refractory ascites is non-negligible.
No curative/preventive therapy - Available pharmacological therapies provide only symptomatic relief.
Delayed diagnosis - The lack of understanding of pathophysiology and clinical relevance may represent a missed opportunity to make the correct diagnosis, which can potentially lead to a delayed diagnosis.
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