The anemia in chronic kidney disease market has struggled as usage of high-selling, standard-of-care, injectable ESAs has declined, especially in the US, due to strict cost controls and an increased risk of CV events when targeting higher Hb levels, which has led to the use of lower Hb targets and more caution when deciding to initiate drug treatment. Biosimilars have also taken their toll, particularly in Europe, where biosimilar short-acting ESAs have taken a majority share of usage. The first biosimilar in the US, Retacrit, was only approved in 2018, but quarterly sales suggest it may be reaching a plateau. The ESAs could lose further share to the oral HIF-PH inhibitors, which are more convenient in non-dialysis patients, reduce the dose of IV iron needed, and have non-inferior efficacy. 

This Datamonitor Healthcare report contains a Disease Analysis module.