As the volume of treatment for patients with heart failure increases due to the aging population, the competition is accelerating in the market for the treatment.

This is because there are more treatment options in clinical practices and higher chances of generics entry into the market.

According to the medical and pharmaceutical industry on August 13th, the medicine market saw significant growth following major academic associations' revision to the guidelines for treating heart failure and the release of major new drugs.

In the current clinical practices, there are '4 pillars' strategy of standard therapy for treating heart failure consisting of 'ARNI/Angiotensin-Converting Enzyme Inhibitor (ACEI),' 'Beta-Blocker (BB),' 'Mineralocorticoid Receptor Antagonist (MRA),' and SGLT-2 inhibitors, which is now expanded its use in addition to diabetes.

Novartis' chronic heart failure treatment 'Entresto (sacubitril/valsartan)' has shown significant growth among these treatments.

Entresto is the first-in-class dual blocker ARNI combining valsartan, an angiotensin II receptor blocker (ARB) inhibitor, and sacubitril, a neprilysin inhibitor. The turning point for this drug was being approved as a first-line treatment for patients who had not been administered ACEI or ARB since March 2022.

In the same year, it became available for prescription to hospitalized patients and outpatients. When the Korean Society of Heart Failure (KSHF) revised 'A Complete Revision of the Heart Failure Guidelines,' it advanced Entresto as the first-line standard therapy for treating heart failure with reduced ejection fraction (HFrEF).

According to the pharmaceutical market research firm UBIST, Entresto generated KRW 57.5 billion in the clinical field last year and recorded KRW 32.9 billion in this year's first half. It has become true that the sales have surpassed those of the previous year.

Another medicine that is receiving attention is 'Verquvo (Vericiguat, Bayer).'

Verquvo, available with reimbursement coverage, can be administered to patients with chronic heart failure (NYHA class Ⅱ-Ⅳ) with an impaired left ventricular contractility and left ventricular ejection fraction (LVEF) of less than 45%. It is a second-line treatment that can be used for patients who have worsened disease despite undergoing standard therapy for over four weeks.

However, it has not yet demonstrated sales growth in clinical practices.

A year after obtaining reimbursement in the second half of the previous year, Verquvo only generated sales of approximately KRW 400 million in the first half this year, based on UBIST.

One reason for this might be the wide variety of treatment options due to the expanded reimbursement range of the original SGLT-2 inhibitor diabetes drugs, including Jardiance (empagliflozin), for chronic heart failures.

Furthermore, while Forxiga (dapagliflozin, AstraZeneca) withdrew from the domestic market, AstraZeneca Korea granted clinical documents to HK inno.N's generic Dapa N, thus Dapa N succeeding Forxiga's heart failure and kidney disease indications. Consequently, Dapa N is the only generic product with the original indication.

The analysis shows that Verquvo is considered a last resort treatment option for treating heart failure in clinical practices. Currently, clinicians have more treatment options they can use.

A cardiology professor from a university hospital in Seoul, who requested to remain anonymous, stated, "Verquvo is used as a second-line treatment following four types of first-line treatment options, so it is not in competition with the first-line treatments." He explained, "SGLT-2 inhibitors were already being prescribed in private practices for diabetes, which reduced the psychological burden and made it easier to prescribe for heart failure. Verquvo is initially prescribed in tertiary hospitals and used as patients move to secondary and primary care hospitals."

"It would have been a different scenario for SGLT-2 inhibitors if it had been initially released as heart failure treatment," he added. "After being used primarily as a diabetes drug, it has gained attention for its effectiveness in treating heart failure. The situation might be different if it were the other way around."