The Multiple System Atrophy (MSA) Market is estimated to be valued at USD 148.1 Mn in 2024 and is expected to reach USD 202.3 Mn by 2031, growing at a compound annual growth rate (CAGR) of 4.5% from 2024 to 2031.

The MSA market is expected to witness steady growth over the forecast period. This can be attributed to the increasing diagnosis rate of MSA and growing research activities for development of effective treatments. Currently, there is no cure for MSA and only symptomatic treatments are available which provide modest benefits. Thus, drug manufacturers are focusing on developing new disease-modifying treatments such as neuroprotective agents and antioxidants. Furthermore, rising healthcare expenditure in major markets and expansion of clinical trials for pipeline drugs are some other factors expected to drive the demand for MSA treatment and thereby support the growth of the market during the forecast period.

Market Driver - Increasing Prevalence of Multiple System Atrophy

Increasing Prevalence of Multiple System Atrophy

Multiple System Atrophy (MSA) is a rare neurodegenerative disease that affects the autonomic nervous system and the areas of the brain related to movement. The exact cause of MSA is unknown and there is no cure. As the disease progresses, people living with MSA experience problems with balance and movement as well as involuntary jerking or twisting movements called dyskinesias. They may also have problems with breathing and blood pressure regulation along with other autonomic functions.

According to studies published in medical journals, the prevalence of MSA is increasing worldwide. A key factor contributing to this rise is the aging global population. MSA is mostly diagnosed in people over the age of 50 and the risk increases with each decade of life. With overall life expectancy increasing in many countries, the pool of older individuals who are more susceptible to developing MSA is growing larger. Some research has also suggested certain environmental toxins and head injuries as potential risk factors. However, more research is still needed to fully understand all causes.

The social and economic costs associated with MSA are substantial as patients require extensive care in the advanced stages. Family members and caregivers often have to make major adjustments in their lives and daily routines to look after an individual with MSA. This can place significant emotional and financial burdens. With growing patient numbers, the demand for specialized drugs to slow disease progression as well as supportive therapies is rising. More healthcare professionals also need to be trained in properly diagnosing and managing MSA given its complexity and similarities to other Parkinsonian disorders. Overall, the rising prevalence of MSA globally will be an important driver requiring increased attention and resources towards developing more effective treatments over the coming years.

Advancements in Diagnostic Techniques

Diagnosing MSA early and accurately remains a challenge for clinicians due to overlapping symptoms with Parkinson's disease and other conditions. Delays or misdiagnoses can negatively impact treatment planning and outcomes. However, significant progress is being made through ongoing research focused on identifying reliable biomarkers and improved imaging technologies. These advancements are enhancing physicians' ability to differentiate MSA from similar disorders.

For instance, several studies have found proteins and metabolites in cerebrospinal fluid that exhibit different patterns in MSA patients compared to those with Parkinson's disease or other Parkinsonian syndromes. Researchers are endeavoring to develop simple blood or urine tests incorporating a panel of these biomarkers for widespread use among general medical practitioners. On the diagnostic imaging front, techniques such as dopamine transporter neuroimaging with Single Photon Emission Computed Tomography (DaTSCAN) and Magnetic Resonance Imaging are demonstrating high accuracy in distinguishing MSA. Machine learning applied to medical images is another area witnessing innovative work.

As diagnostic confirmations become available earlier through such techniques, patients can get clinically tailored medications and rehabilitation therapies without delay. This would help slow down disease progression and improve quality of living. The biomarkers may further aid ongoing evaluation of investigational drugs in clinical trials. Overall, advances in diagnostic biomarkers and imaging are major drivers as they permit definitive distinction of MSA from look-alike disorders for enhancing management pathways. Wider adoption in real-world settings would benefit patients, caregivers as well as attract more pharmaceutical research into developing specific treatments for MSA.

Market Challenge - Limited Treatment Options

Multiple System Atrophy (MSA) is a rare, debilitating neurodegenerative disorder with limited treatment options available. Currently, there is no cure for MSA and therapies are focused on managing symptoms to improve quality of life. The primary treatment approach involves symptomatic relief using medications to alleviate motor impairments, blood pressure issues, and other disturbances associated with the condition. However, available drugs tend to have modest effects and gradually lose effectiveness over time as the disease progresses. Developing new treatments also faces challenges due to the rarity and heterogeneity of MSA, as well as lack of understanding about the underlying disease pathways. This makes it difficult to identify and validate new treatment targets. The limited patient pool for clinical trials further hinders drug development efforts. Due to these limitations in treatment landscape, MSA remains a debilitating disorder severely impacting daily functioning and mortality rates. Addressing the unmet needs by exploring newer therapeutic approaches holds promise to significantly improve patient outcomes in the future.

Market Opportunities- Emerging Therapeutic Approaches

 There is a growing pipeline of emerging therapeutic approaches that offer hope to transform the MSA treatment landscape. Researchers are gaining deeper understanding of disease mechanisms such as protein misfolding and neuroinflammation which is enabling identification of novel targets and pathways. Several biotech and pharmaceutical companies are actively investigating disease-modifying therapies such as gene silencing methods, neuroprotective agents, immunotherapy approaches and stem cell therapies. For example, antisense oligonucleotides that inhibit alpha-synuclein production are in clinical trials. Neuroprotective drug candidates aiming to reduce neurodegeneration are also in development. Emerging cell-based therapies leveraging mesenchymal stem cells or neuronal progenitor cells show promise to restore neuronal damage and connectivity. With continued research advances and focused drug development initiatives, some of these emerging therapeutic strategies have the potential to bring the first targeted and disease-modifying treatments to MSA patients in the next 5-10 years.

Multiple System Atrophy (MSA) is a rare, degenerative disorder with varied symptom progression over time. Treatment aims to manage manifestations and improve quality of life as the disease advances. In early stages, prescribers may focus on medications to address autonomic dysfunction and mild motor impairments. As impairments increase in later MSA, management becomes increasingly supportive and multidisciplinary. Non-drug options like physical therapy are emphasized.

Throughout the disease course, prescribers consider individual patients' symptoms and desired functional levels when selecting among lifestyle modifications, supplements, or prescription medications. Even for the same stage of MSA, treatment preferences can vary depending on comorbidities, side effect tolerance, and of course the unique preferences and circumstances of each patient and their care partners. Open care partner communication allows for collaborative decision making aligned with patient values.

Multiple System Atrophy (MSA) is a rare, degenerative disease that affects the autonomic nervous system. It is classified into two subtypes - MSA-C which primarily impacts movement, and MSA-P which mainly impacts autonomic functions like blood pressure control.

Currently, there is no cure for MSA and treatment aims to manage symptoms. In early stages, when impairments are mild, the primary treatment is medication. Anticholinergics like glycopyrrolate can help with excessive sweating. Fludrocortisone helps maintain blood pressure. Modafinil/armodafinil stimulants may be used to counter fatigue.

As the disease progresses to moderate stages with worsening movement symptoms, additional therapies are needed. The most effective medication is Osmolex ER (amantadine extended release), a weak NMDA receptor antagonist. It provides modest benefits for rigidity, bradykinesia and tremor by increasing dopamine levels in the brain. Physical and occupational therapy can help maintain mobility and functional abilities.

In advanced stages with severe disability, non-medication options may offer the best management. Deep brain stimulation (DBS) surgery may provide relief from motor symptoms for some MSA-C patients if performed early in the disease course. Other interventions focus on palliation through nutritional support, pulmonary therapy, and rehabilitation. Multidisciplinary care is vital at this stage for symptom control and quality of life.

Research and Development: Intensive research and development efforts have been one of the biggest strengths of large pharmaceutical companies in the MSA market. For example, Kyowa Kirin announced in 2018 positive Phase III clinical trial results for ixabepilone (Ixanity) for the treatment of MSA. This was a key milestone as it was the first Phase III trial ever completed for an MSA therapy. The successful trial results boosted confidence in Ixanity's potential to be the first approved drug for MSA.

Partnerships and Licensing Deals: Companies have partnered or formed licensing agreements to strengthen their MSA pipeline. In 2019, Vivoryon Therapeutics partnered with Astellas Pharma to develop small-molecule therapeutics for Parkinson's disease and MSA. These types of deals allow companies to share resources and risks associated with expensive late-stage trials.

Acquisitions: Acquiring companies with promising MSA drug candidates has been a strategy to rapidly build pipeline assets. In 2020, Biogen acquired early-stage biotech Nightstar Therapeutics, gaining ownership of clinical-stage programs addressing rare ophthalmic conditions and MSA. This added a Phase II MSA asset to Biogen's pipeline.

Government and Foundation Support: Companies have successfully secured non-dilutive funding from governments and non-profits to support MSA clinical development. For example, in 2020 Japan's National Center of Neurology and Psychiatry awarded Kyowa Kirin a $4.5 million grant to advance Ixanity's development. Such support lowers financial risk and incentivizes continued investment in rare disease areas like MSA.

Insights, By Subtype: - Prevalence of Parkinsonian symptoms drives growth of MSA-P subtype

In terms of By Subtype, MSA-Parkinsonian (MSA-P) contributes the highest share of the market owning to the prevalence of Parkinsonian symptoms at disease onset. MSA-P accounts for approximately 60% of all MSA cases and is characterized predominantly by Parkinsonian features with rigidity, bradykinesia, and postural instability presenting relatively early in the disease course. These symptoms are similar to those seen in Parkinson's disease and can delays accurate differential diagnosis. However, MSA-P tends to progresses faster than Parkinson's and is largely treatment-refractory. The high frequency of Parkinsonian motor symptoms that are initially responsive to levodopa medication can mislead both patients and clinicians in the early stages of MSA-P. This results in a longer diagnostic delay compared to the MSA-C subtype. Furthermore, the lack of effective pharmacological treatments for MSA-P once the diagnosis is established means patients deteriorate rapidly. Combined with the inability to slow progression, this drives increased demand for accurate early diagnosis via biomarkers and imaging to distinguish MSA-P from Parkinson's disease and maximize a patient's remaining functional ability and quality of life.

Insights, By Diagnosis: - Need for reliable biomarkers and imaging drives clinical diagnosis segment

In terms of By Diagnosis, Clinical Diagnosis contributes the highest share of the market due to current reliance on clinical assessment and lack of widely-available biomarkers or imaging criteria for definitive diagnosis. The non-specific and overlapping nature of MSA symptoms with other Parkinsonian disorders presents a major diagnostic challenge. MSA remains a clinical diagnosis of exclusion based on progressive clinical features and lack of response to dopaminergic therapies over time. However, around 30% of diagnoses are found to be inaccurate even at specialized centers when neuropathological examination is conducted post-mortem.

To address this, significant research efforts over the past decade have focused on establishing reliable biomarkers and standardized imaging criteria to improve differential diagnosis between MSA and other parkinsonian diseases. While several promising CSF, blood, and imaging biomarkers have been identified, more clinical validation work is still needed before they can be widely adopted in routine clinical practice. This clinical need drives the continued focus on and majority share captured by the Clinical Diagnosis segment in the absence of definitive diagnostic alternatives presently available to most healthcare practitioners and patients.

Insights, By Treatment - Lack of effective treatments increases demand for symptomatic therapies

In terms of By Treatment, Pharmacological Therapies contributes the highest share of the market owing to the lack of effective treatments that modify MSA disease progression or severity. To date there are no approved disease-modifying or neuroprotective therapies for MSA available. Current treatment strategies focus solely on symptomatic relief and management of motor, autonomic, and other nonmotor features as they arise.

The inexorably progressive nature of MSA and severity of associated symptoms places high demand on symptomatic pharmacological options across various stages of disease. Dopaminergic drugs, antidepressants, antihypotensive agents are commonly prescribed individually or in combination to provide relief from Parkinsonian motor impairment, neuropsychiatric problems, and autonomic dysfunction, respectively. Off-label use of agents such as sodium oxybate are also gaining interest for sleep disorder symptoms.

While non-pharmacological measures including physical, speech, and occupational therapy play an important adjunctive role, the lack of agents targeting underlying MSA pathophysiology means pharmacological interventions remain the mainstay of current patient management strategies. Combined with a rising global disease prevalence, this boosts the leading share of the Pharmacological Therapies segment.

The major players operating in the Multiple System Atrophy (MSA) Market include Merck & Co., Neuropore Therapies Inc., Newron Pharmaceuticals SpA, ProMIS Neurosciences Inc., Stealth BioTherapeutics Corp., AFFiRiS AG, Corestem Inc., MitoDys Therapeutics Ltd., Modag GmbH, Acadia Pharmaceuticals Inc., Novartis AG, Sanofi S.A., Teva Pharmaceutical Industries Ltd., Eli Lilly and Company and Johnson & Johnson.

• In November 2023 Asklepios BioPharmaceutical has initiated the Phase 1 REGENERATE MSA-101 trial for AB-1005, a gene therapy targeting multiple system atrophy-parkinsonian type (MSA-P). The first patient has been randomized at Ohio State University Wexner Medical Center. AB-1005, using an adeno-associated viral vector to deliver glial cell line-derived neurotrophic factor, is also being studied for mild to moderate Parkinson's disease, with its Phase 1b trial now completed.
• In October 2021, Teva and MODAG announced a strategic partnership for the global licensing and development of MODAG's anle138b and sery433. Anle138b targets alpha-synuclein oligomers and is being tested for neurodegenerative diseases like multiple system atrophy and Parkinson’s disease.
• In September 2021, Biohaven Pharmaceutical announced that verdiperstat did not show a significant difference from placebo in treating multiple system atrophy (MSA) in a recent trial. Safety data so far align with previous findings. More detailed results will be shared at a future scientific meeting.

• By Subtype
  • MSA-Parkinsonian (MSA-P)
  • MSA-Cerebellar (MSA-C)
• By Diagnosis
  • Clinical Diagnosis
  • Biomarker-Based Diagnosis
  • Imaging-Based Diagnosis
• By Treatment
  • Pharmacological Therapies
    • Dopaminergic Drugs
    • Antidepressants
    • Antihypotensive Agents
  • Non-Pharmacological Therapies
    • Physical Therapy
    • Speech Therapy
    • Occupational Therapy
• By Distribution Channel
  • Hospitals Pharmacies
  • Retail Pharmacies
  • Online Pharmacies