The postherpetic neuralgia market is estimated to be valued at USD 756.1 Mn in 2024 and is expected to reach USD 1,157.5 Mn by 2031, growing at a compound annual growth rate (CAGR) of 6.3% from 2024 to 2031. The increasing prevalence of Herpes Zoster infections globally is expected to drive the demand for treatment of postherpetic neuralgia.

Market Driver - Rise in Varicella-Zoster Virus Infections

Overall number of zoster virus infections has been rising in recent years due to aging populations. It is happening also because primary chickenpox infections are declining in the developed world due to widespread vaccination programs. With reduced natural boosting of immunity, more people are at risk of shingles as they get older.

While chickenpox vaccination has been highly successful in reducing the disease burden, it may be inadvertently contributing to increasing shingles cases in the long run. Since thevaricella virus remains latent lifelong after primary infection, increased shingles cases will continue emerging over the coming decades. This rising trend of zoster infections is expanding the at-risk population for developing postherpetic neuralgia.

More cases of acute zoster pain are expected to evolve into the chronic and often debilitating stage of postherpetic neuralgia. This is expected to bolster growth of the postherpetic neuralgia market in the coming years.

Market Driver - Growing Focus on Non-opioid Pain Management Strategies

Ongoing epidemic of opioid abuse and overdoses has intensified scrutiny on prolonged use of these drugs even for legitimate medical purposes. Regulators and healthcare providers are seeking safer alternatives for chronic non-cancer pain conditions like postherpetic neuralgia. This has created opportunities for new treatments targeting the specific pathophysiology of neuropathic pain.

Drug makers are exploring disease-modifying mechanisms beyond symptomatic relief. Some candidate therapies aim to prevent or reverse nerve damage during the acute zoster infection stage before pain pathways become established. Non-opioid topicals, patches and creams are being studied for localized treatment.

Research into neuromodulation techniques like TENS, acupuncture and cognitive behavioral therapy is ongoing. Multimodal strategies combining pharmacological and non-pharmacological components also hold promise. Overall, the drive towards minimizing opioid exposure where possible is directing innovation towards tackling the root cause of postherpetic neuralgia. This shift in clinical approach presents sizable commercial opportunities in the postherpetic neuralgia market.

Market Challenge - High Resistance to Treatment in a Significant Portion of Patients

One of the major challenges faced in the postherpetic neuralgia market is the high resistance to treatment in a significant portion of patients affected by the condition. Currently available treatment options include antiviral medications, antidepressants, gabapentin, and lidocaine patches. However, research shows that nearly 30-40% of patients experience little to no pain relief even after trying multiple treatment lines.

The pathophysiology of neuropathic pain in postherpetic neuralgia patients is still not fully understood. This has made it difficult for physicians to determine the most effective treatment regimen for individual patients.

The differing efficacy of existing treatments across patients points to the need for more targeted therapies that can address the underlying reasons for drug resistance in recalcitrant patients. This resistance to available medications poses a major hurdle in effectively managing pain and reducing the health burden of postherpetic neuralgia.

Market Opportunity - Development of New Treatments Targeting Neuropathic Pain

One of the key opportunities in the postherpetic neuralgia market lies in the development of new treatments that can better target the underlying mechanisms of neuropathic pain. Currently, none of the medications available are specifically designed to act on neuropathic pain pathways.

Researchers are actively exploring new compounds and molecular targets that can more effectively interrupt pain signaling in the peripheral and central nervous system. Some potential areas being studied include sodium channel blockers, N-methyl-D-aspartate receptor antagonists, alpha-2 delta ligands, serotonin-norepinephrine reuptake inhibitors, and nerve growth factor inhibitors.

Clinical success of any new treatments in phase 2 and 3 trials could enable better management of postherpetic neuralgia symptoms and open up new revenue streams. Moreover, novel delivery methods such as patches, implants and stem cell therapies also offer scope for minimally invasive pain relief. Effectively targeting neuropathic pain holds out the promise of transforming postherpetic neuralgia management over the coming years.

Postherpetic neuralgia (PHN) is a common and often chronic complication of shingles. Treatment approaches vary depending on the stage and severity of symptoms. For mild to moderate acute pain, prescribers commonly opt for topical lidocaine patches or oral anticonvulsants like gabapentin (Neurontin). These options provide adequate relief without severe side effects.

However, as PHN becomes more chronic and severe, prescribers tend to transition patients to stronger treatments. At this stage, analgesics like pregabalin (Lyrica) are frequently prescribed. As the first-line oral agent endorsed by pain treatment guidelines, Lyrica is perceived as safe and effective. If pain persists, prescribers may add tricyclic antidepressants like amitriptyline (Elavil) or back patches containing lidocaine.

For refractory cases where pain significantly impacts quality of life, prescribers resort to opioids. Commonly used first-line opioid options include tramadol (Ultram) and oxycodone (Oxycontin). Fentanyl (Duragesic) patches are another preferred brand prescribed for around the clock relief from constant severe PHN pain.

Postherpetic neuralgia can cause persistent pain after a shingles outbreak. Treatment depends on the stage and severity of symptoms.

In the early acute stage during shingles outbreak, antivirals like famciclovir, valacyclovir or acyclovir are prescribed to shorten the duration of rash and pain. Lidocaine patch 5% is often used to relieve neuropathic pain.

As shingles rash heals but pain persists for 3 months or more, it is considered postherpetic neuralgia. First line treatment includes gabapentin, pregabalin and duloxetine which are commonly prescribed antidepressants and anticonvulsants but are also effective in managing neuropathic pain. Lidocaine patch continues to provide relief.

For moderate to severe PHN non-responsive to first line treatments, opioid analgesics like oxycodone combined with gabapentin/pregabalin provide synergistic pain relief. However, the risk of side effects and addiction limit their long-term use.

In refractory cases, topical capsaicin cream 0.075% is applied for pain relief. If symptoms are still inadequately controlled, new medications like tapentadol (Nucynta) which has both opioid and norepinephrine reuptake inhibition or the N-methyl-D-aspartate receptor antagonist melitracen (Axsain) are considered.

Product innovation: Players have focused on developing innovative drug therapies to treat postherpetic neuralgia more effectively. For example, in 2017, Pfizer launched Qutyplex, a prescription cream containing lidocaine for topical use. It was found to significantly reduce pain from postherpetic neuralgia within 1 hour of application.

Strategic acquisitions: Companies have enhanced their pipelines through strategic acquisitions of therapies in late stage trials. For example, in 2018, Grunenthal acquired worldwide rights to A3174, an oral TRPV1 antagonist being developed by Astellas for postherpetic neuralgia. This allowed Grunenthal to strengthen its pain portfolio by gaining a promising late-stage asset. In clinical trials, A3174 showed potential to relieve PHN pain with just one daily dose. The acquisition eliminated competition and positioned Grunenthal as a leader in oral therapies.

Partnerships for expanded access: Players partnered with community health organizations to improve patient access to treatments. For example, in 2015, Merck partnered with Visiting Nurse Association health groups to set up clinics providing subsidized access to RALIVIA (alfinetypram HCl), an oral capsaicin formulation.

Insights, By Treatment: Anticonvulsants Witness Increasing Patient Preference

In terms of treatment, anticonvulsants are projected to hold 34.7% share of the postherpetic neuralgia market in 2024, owning to increasing patient preference. Anticonvulsants such as gabapentin and pregabalin are widely prescribed as first line treatment for postherpetic neuralgia. They work by blocking calcium channels in the brain and nervous system, which helps to reduce pain signal transmission.

Compared to other treatment types, anticonvulsants provide adequate relief from chronic neuropathic pain with relatively lesser side effects. They have advantages such as quick onset of action, oral administration, and proven long-term efficacy and safety.

Additionally, physicians are increasingly recommending anticonvulsants due to their relatively better risk-benefit profile. Unlike opioids, they carry a lower risk of developing tolerance and dependency.

Moreover, patients experience less stigma associated with its use compared to treatments like antidepressants. Their easy availability across various pharmacy channels also contributes to increased adoption rate. Therefore, proven clinical efficacy, favourable side effect profile and rising patient acceptance have led to anticonvulsants becoming the go-to first line therapy. This results in the segment garnering the highest share in postherpetic neuralgia market.

Insights, By Distribution Channel: Growing Role of Hospitals

In terms of by distribution channel, hospital pharmacies are projected to account for 46.5% share of the postherpetic neuralgia market in 2024, owning to growing role of hospitals. Hospitals play an important role in the diagnosis and initiation of treatment. They have specialist doctors who can comprehensively evaluate patients and recommend the best therapeutic regimen.

Additionally, prescription from hospital pharmacies ensure patients get access to branded versions which have more robust clinical data backing their efficacy.

Hospital visits also allow physicians to regularly monitor response, adjust dosage and switch therapies if required. This level of clinical oversight and customized care is crucial in chronic pain management. It alleviates issues like dose compliance, medication reactions and therapy failures which often arise with retail pharmacy prescriptions.

Furthermore, hospital pharmacies stock entire product ranges from all manufacturers which gives doctors flexibility in prescribing. They can source even imported or less common brands. specialized expertise and accessibility are driving higher share for hospital pharmacies in the postherpetic neuralgia market.

• The United States accounted for approximately 70% of the postherpetic neuralgia market size in 2023.
• The total incident cases of postherpetic neuralgia in the 7MM were around 600,000 in 2023. It affects about 10-20% of individuals who have had shingles, especially adults over age 60.
• Recent approvals of new medications have expanded the postherpetic neuralgia market. Partnerships between pharmaceutical companies have accelerated R&D efforts for innovative therapies. Furthermore, increased educational initiatives have improved early diagnosis and management of postherpetic neuralgia.

The major players operating in the postherpetic neuralgia market include Pfizer Inc., GlaxoSmithKline plc, Novartis AG, Teikoku Pharma USA, Astellas Pharma Inc., BioDelivery Sciences International, Inc., Zogenix, Inc., Sorrento Therapeutics, Inc., Assertio Therapeutics, Inc., and Horizon Therapeutics plc.

• In September 2023, GlaxoSmithKline plc received FDA approval for an extended-release antiviral medication, potentially reducing the incidence of Postherpetic Neuralgia
• In June 2023, Pfizer Inc. announced the successful Phase III trial of a new anticonvulsant drug, enhancing pain management for postherpetic neuralgia patients.
• In April 2023, Novartis AG launched a patient assistance program to improve access to PHN treatments, impacting patient adherence positively. Novartis has a long-standing commitment to patient assistance through its Novartis Patient Assistance Foundation (NPAF), which helps patients access medications they may otherwise not afford.

• By Treatment
  • Anticonvulsants
    • Gabapentin
    • Pregabalin
  • Antidepressants
    • Tricyclic Antidepressants
    • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Topical Analgesics
    • Lidocaine Patches
    • Capsaicin Creams
  • Opioids
    • Morphine
    • Oxycodone
  • Steroids
    • Corticosteroid Injections
• By Distribution Channel
  • Hospital Pharmacies
    • Inpatient Pharmacies
    • Outpatient Pharmacies
  • Retail Pharmacies
    • Chain Pharmacies
    • Independent Pharmacies
  • Online Pharmacies
    • Company-owned Websites
    • Third-party Platforms