The diabetic nephropathy (DN) market is complex, because in addition to specific mechanisms that directly impact the disease, blood pressure and glycemic control are additional general targets that affect the condition. Moreover, there is high cardiovascular (CV) risk in DN patients, and many physicians may be more concerned about that than the risk for end-stage renal disease, especially in less advanced patients. Hence, drugs that directly impact DN and also benefit these other targets or have a CV benefit can have a competitive advantage. 

The antihypertensive ACE inhibitors or ARBs have been the mainstay of specific treatment for type 1 and type 2 DN as they have renal benefits beyond blood pressure lowering. Usage increases at first with greater renal impairment, though it may decline in stage 4 due to concerns about complications of hyperkalemia or deterioration of renal function in more advanced patients. Patients may also be receiving these classes for hypertension, which is present in most patients with DN, or for other CV indications, without a specific intention of treating DN. 

This Datamonitor Healthcare report contains a Disease Analysis module.