How Africa, Asia could benefit from Ticagrelor’s WHO listing

Anglo-Swedish multinational pharmaceutical and biotechnology company, AstraZeneca Plc, has recently applied to World Health Organization (WHO) for the inclusion of Ticagrelor, sold under brand name Brilinta, in the list of treatments for prevention of atherothrombotic in adult patients with acute coronary syndromes (ACS). (1)

The inclusion of ticagrelor in WHO’s model list of essential medicines is not only likely to boost ongoing effort to tackle increasing ACS cases in low- and middle-income countries in Africa and Asia but also spur further growth of the global active pharmaceuticals ingredient (API) market.

Ticagrelor, a generic version of Brilinta from AstraZeneca Pharmaceuticals, acts as a platelet aggregation inhibitor by antagonising the P2Y12 receptor that is found on the surface of the thrombocytes. Ticagrelor prevents the platelets from collecting and forming clots that could lead to a heart attack or a stroke.

According to US’ Food and Drug Agency (FDA), ticagrelor, co-administered with acetylsalicylic acid, lowers “the risk of having another heart attack, or dying from a heart problem after a heart attack or severe chest pain.”

Ticagrelor is a round and yellow product that has been approved in over 115 countries for ACS and in 80 countries for high-risk patients with history of heart attack.

FDA, which says Brilinta “like other antiplatelet agents, can cause significant, sometimes fatal bleeding”, approved ticagrelor in 2018, in 60 and 90 mg doses. (2)

Furthermore, AstraZeneca, which is the largest pharmaceutical company by sales value in the hospital sector in China, says in 2021 ticagrelor “received expanded use in the US beyond cardiovascular disease to patients with mild-to-moderate stroke.”

Some of the top ticagrelor producers in the global market include WuXi AppTec Ltd, Piramal Pharma Solutions, Hisun USA Inc, Dr Reddy’s Laboratories Ltd, Alexion, Ingelheim, Roche, Ingelheim Pfizer, Pfizer, GSK, Boehringer, Amgen, Boehringer, Merck, Amgen, and Eli Lilly. (3)

AstraZeneca, which generated US$1,472m in revenues from Brilinta sales in 2021, has in its application to WHO said listing of ticagrelor in the model list of essential medicines would boost treatment of the increasing cardiovascular disease (CVD)-related complications especially in Asia and Africa. (4)

“Indeed, among nations with high COVID-19 mortality, China is forecast to have the highest growth rate for CVD mortality indicating the country has less time to implement control and preventive measures to reduce the overall impact on health systems,” the application by AstraZeneca says. (1)

There has been substantial growth in rates of hospitalisation, mortality, probability of CVD death and stroke regions such as Albania, Asia-Pacific, Iran, Kazakhstan, Pakistan, and Sub-Saharan Africa, the application says. (1)

“There is also continuously increasing CVD mortality rate, with a high proportion of premature CVD deaths in Asia,” AstraZeneca says in its application.

In Asia, CVD was shown as top cause of death in 2019, accounting for an estimated 10.8 million deaths, equivalent of 35% of the total deaths in this continent of 4.6 billion people. This was an increase from the 5.6 million deaths reported in 1990, when the CVD deaths accounted for 23% of total mortalities in the Asian continent. (1)

The CVD-related diseases in Asia have been attributed to changes in the continent’s demographics, socioeconomics, living environments, as well as lifestyles according to the submission to WHO.

Elsewhere, the demand for ticagrelor is likely to grow in Africa because of ongoing initiatives to reduce the CVD mortality rates in the continent.

For example, the WHO Global Action Plan for the prevention and Control of non-communicable disease targets a 25% reduction in premature CVD mortality by 2025 and a third reduction for premature NCD mortality by 2030. (5)

An estimated 1.09 million people dies from CVD epidemics in Africa in 2019, accounting for the highest mortality attributed to non-communicable diseases in Africa. (6)

References;

1. https://cdn.who.int/media/docs/default-source/essential-medicines/2023-eml-expert-committee/applications-for-addition-of-new-medicines/a45_ticagrelor.pdf?sfvrsn=82b339e9_4

2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/022433s031lbl.pdf

3. https://www.linkedin.com/pulse/ticagrelor-market-share-potential-growth-demand-analysis-arpita-gupta/

4. https://www.astrazeneca.com/content/dam/az/Investor_Relations/annual-report-2022/pdf/AstraZeneca_AR_2022.pdf

5. https://www.who.int/teams/noncommunicable-diseases/governance/roadmap

6. https://www.openaccessgovernment.org/cvds-cardiovascular-diseases-in-africa-world-health-organisation/149388/

About the Author

Shem Oirere graduated from the University of South Africa with a bachelor’s degree in International Relations and Diplomacy, and also holds a Diploma in Journalism from the London School of Journalism. He previously worked for the Kenya Times, Nation Media Group and The People Daily over a twenty-year span as a business writer and Sub-editor. He wishes to share a view of the scenes behind Africa's latest pharma market trends with the rest of the world.