Behavioral Disorders: ADHD and beyond

Over the past decade, behavioral disorders have received increasing attention, both from the media and medical professionals, however only attention deficit/hyperactivity disorder has emerged as a key market. Poor awareness and low treatment rates have in the past limited market opportunity, but pharmaceutical companies should be aware that the new understanding of behavioral disorders will lead to increased potential in the sector. In Behavioral Disorders: Opportunities to shape future markets , Datamonitor examines today's behavioral disorder market, providing key insight into why this sector remains largely untapped save for attention deficit/hyperactivity disorder (ADHD). The Market Brief also examines some of the other areas that hold great promise for future development, together with the strategies pharma companies should employ to maximize their success. Lack of understanding... In common with mental health issues in general, the level of understanding of behavioral disorders is relatively low. In the public domain, mental health is virtually a taboo subject and there is often an unwillingness to confront and acknowledge the issue of behavioral disorders. This in itself poses a problem in that many behavioral disorders only come to light when the patient themselves realizes they have a problem and goes to their doctor. Thus it becomes even more important to educate the public to the issues, as low public understanding means that fewer people present themselves to physicians, leading to lower rates of diagnosis and a lower treatable population. This is exacerbated from a clinical point of view as the causes and origins of many of these complex conditions largely remain a mystery. Diagnosis itself is notoriously difficult, which puts a further pressure on the accuracy of data on patient numbers. In addition, treatment can be far from straightforward, requiring the use of pharmaceutical drugs in tandem with psychological techniques such as counseling. In order to gain as much information about the numbers, causes, origins and other contributing factors of these disorders, pharmaceutical companies should invest in strategies to persuade government and public health organizations to use their clout to research these areas. With reliable data on these disorders, pharmaceutical companies will be enabled to make informed decisions about these emerging disease markets. ...but increasing awareness? In spite of the relative lack of understanding, both amongst the public as well as in the wider healthcare community relating to behavioral disorders, it can be said that awareness of these conditions is slowly rising. Over the past decade, an increasing amount of media attention has been directed at conditions like Tourette's syndrome (TS). Furthermore, the past 10 years has also seen the growth and development of a healthy ADHD marketplace, which should have gone some way towards bringing these other related conditions to the fore. However, the experience of Teva Pharmaceuticals relating to its drug Orap (pimozide) should serve as a note of caution. The only drug ever to be approved for a non-ADHD behavioral disorder, Orap is indicated for the treatment of TS. However, the drug's usage is low, and Datamonitor believes this is due to Teva being primarily known as a generic manufacturer, which resulted in a weak marketing. The implication is that without adequate marketing to educate physicians and the wider public as to the latest prescribing options, any drug will struggle. And the promotion of drugs into off-label uses would seem to bear this out. Although there has been some marketing of drugs into non-ADHD behavioral disorders, this has been low as companies are limited to the use of clinical trial data, as more robust marketing techniques are only permitted for drugs specifically indicated for a particular disorder. A return to origins Another major barrier to entering the non-ADHD behavioral disorder markets is the disorders’ etiologies, or their causes and origins. Firstly, these are largely undefined, which is a problem in itself but more seriously, what few symptoms are identifiable often crossover with disorders that have a more mature market. For example, the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association states that in order to diagnose intermittent explosive disorder (IED), aggressive symptoms should not first be better accounted for in six other conditions. Although the low incidence and the difficulty in diagnosing many of these disorders means that the treatable population will always be relatively low, Datamonitor believes there are significant opportunities for companies to decrease the risks of targeting these markets. For example, companies should focus on specific symptoms, which will enable multiple disorders to be targeted. These symptoms are likely to be aggression and impulse because they are common across many different behavioral disorders. By adopting this strategy, the patient potential is increased and the higher use of drugs will increase physician familiarity with prescribing them for the overall treatment of behavioral disorders. Datamonitor believes that there is potential for ADHD drugs like Eli Lilly Straterra or Janssen's Risperdal to gain indications for treating impulsivity in conduct disorder (CD), IED, and impulse-control disorder not otherwise specified (ICDNOS). In addition, screening programs should be implemented to identify those suffering from behavioral disorders. In the same way that teachers identify children with potential ADHD, populations containing high numbers of sufferers of non-ADHD behavioral disorders should be targeted. For example, CD is highly comorbid with ADHD, and as such ADHD patients can be screened for CD. Future potential Behavioral disorders have long been a poor relation in healthcare. With little understanding amongst clinicians and the general public alike, it is only in the past few years that they have risen to any sort of prominence. At present companies have only targeted the highest-profile of the disorders, most notably ADHD. There still exist major untapped market opportunities for today's pharmaceutical industry, both with currently marketed drugs as well as for pipeline products. The first step to this will be raising awareness and understanding amongst patients and doctors through the use of improved marketing. In the longer term, screening programs and a general movement away from the treatment of specific diseases to the targeting of common, cross-disorder symptoms, should set pharmaceutical companies in good stead for success in the emerging behavioral disorder market.