The Vascular Stents Market in Asia

A case for high performance

Vascular stents are ‘spring-like’ cylindrical and hollow metal-based implantable devices for the treatment of vessel related blockages. It was supported by medical professionals to be a viable alternative to percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) for the treatment of coronary atherosclerosis. Since the early 1990s, bare metal stents have started their implantation in patients throughout Asia. Cardiac surgeons have since then preferred the use of stents compared to balloon angioplasty as the rate of re-stenosis amongst patients have shown to decrease to about 20 to 25 percent as opposed to PTCA’s 30 to 40 percent. Even though stents implantation is a costlier alternative to PTCA, the fact that it can prevent patients from a relapse and the need to receive a second interventional procedure warrants its increasing demand.

Problems still persist in bare metal stents

Though demand for bare metal stents has exceeded cheaper balloon angioplasty, the use of stents is not without problems. Being an implanted device, the human body tissue detects such devices as a foreign particle resulting in initial hyperplasia, a condition whereby endothelial cells grow to envelop the bare metal stents. This has been the main cause of re-stenosis amongst patients.

In order to counter this, researchers have come up with drug-coated stents. This coated drug acts as agent to inhibit tissue growth and thus prevent re-stenosis. These stents are referred to in the industry as drug-eluting stents (DES) as they have the capability to release drugs at a constant rate. The 2 most common drugs utilized in stents are Paclitaxel, which is licensed by Bristol-Myers, and Squibb and Sirolimus, which is marketed by Wyeth Pharmaceuticals. Both of these drugs are suppressant drugs. Paclitaxel is used to treat tumor growth and Sirolimus prevents organ rejection.

DES under the limelight

In late 2005, the FDA approved only two drugs for drug-coated stents. - Cypher Sirolimus-eluting stents by Johnson & Johnson vascular devices arm Cordis Corporation and Taxus Express Paclitaxel-eluting stents by Boston Scientific.

However, at that time the DES market in Asia, valued at around US$ 1.5 billion, already had several other smaller companies competing for it. Homegrown medical device companies in China and India like MicroPort Medical and Sahajanand Medical Technologies are making waves in the market with their proprietary DES designs, referred to as the Firebird stents and Infinnium stents respectively. Other companies like Guidant Corporation and Biosensors International have their DES already approved with the CE Mark in Europe. Additionally, Biosensors have established a new DES design using a proprietary drug named Biolimus. The clinical trials for this flagship DES called Biomatrix are conducted in association with another large medical device company, Terumo Corporation. The interest being shown by large medical device companies further proves the point that DES is the way to go in the near future.

Competitive market for stents in Asia

With more players and increasing number of competitors with cheaper and newer products in the Asian market, the stents market has grown to become more competitive lately. Globally, we have seen the acquisition of Guidant by Boston Scientific and the sale of Guidant’s DES business to Abbott Vascular Devices. Thus it will only be a matter of time before Abbott enters the highly lucrative market for DES. Recently listed in Singapore, Biosensors International is extensively conducting clinical trials of its Biomatrix stents, which is due for launch sometime this year if not next year.

While product offerings in the DES market continue to increase, other medical device companies are diligently trying to make waves in this market. For example, Hong Kong based Orbus Neich have developed a Bio-engineered stents that uses biocompatible coatings to incite healing of tissue but at the same time prevent re-stenosis. Sold at a cost lower than DES, the Genous stents by Orbus Neich offers a real alternative to the increasingly swarming market of DES.

Innovation is the key to increasing market share

Innovation has become the crucial factor with more companies competing in this market. This is even more evident for companies, which already have DES in their product portfolio. As one of the leaders in the DES markets Boston Scientific has launched an improved version of the Taxus Paclitaxel-eluting stents. This revised DES, called the Taxus Liberte, is based on the Taxus Express platform but boasts better implant ability as well as a more versatile design. It is widely expected that this new DES will allow Boston Scientific to win back some market share it lost to Cordis.

Besides improving on existing designs, new entrants to the market have re-positioned themselves by announcing latest technologies to differentiate their specialized features. A typical example is Conor MedSystems that launched their CoStar Paclitaxel-eluting stents with an innovative feature – DES made of cobalt chromium alloy instead of the usual stainless steel. Cobalt alloy is known to be the new biomaterial used in medical devices, as it offers several advantages over stainless steel. It is lightweight and thin size calls for easy implantation procedures.

Other biomaterial applications in the stents industry include the use of Nitinol, a nickel based alloy that will self-expand stents. Nitinol is a shape-memory alloy that can change its shape upon slight changes in temperature, and is found in various medical devices applications. Nitinol based stents can be implanted via a guide wire and upon placement, the stents will heat up and expand. However the use of such stents has generally been constricted to peripheral stents. The reason behind this is that present manufacturing technologies still make it difficult and expensive to produce thin Nitinol-based cross sections that are necessary for coronary stents.

Companies seeking to enter this competitive market should promote their brand equity through sponsorships of clinical trials, large-scale conferences highlighting product implantation success rates and by long-term partnerships with leading implanting centres. The latter is especially beneficial for marketing in Asia as many Asian countries like Malaysia and Singapore have a central cardiac care medical institution, which forms the main centre in the country for cardiovascular surgery.

Market growth rate and potential remains huge

Frost & Sullivan forecasts that the growth in the sales of vascular stents in Asia would outpace that of European and American markets between 2006-2010 due to rising incomes, better health insurance coverage, and high prevalence of cardiovascular diseases. The vascular stents market is expected to grow at an annual compounded growth rate of between 6 to 20% for countries in Asia. Patients suffering from cardiovascular diseases like coronary atherosclerosis within Asia could be as huge as 700 million by 2008. This clearly indicates the potential for stents manufacturers to enter this fast-growing vascular stents market.

Media Contact:
Jasminder Kaur
Corporate Communications
P: 65 6890 0937
F: 65 6890 0988
E: jkaur@frost.com
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