The competition among drugmakers over non-vitamin K antagonist oral anticoagulants (NOAC) is getting ever more severe, as the NOAC became the latest trend in the blood thinner market.

According to data from market researcher UBIST, prescriptions of major NOAC products jumped to 33.9 billion won ($29.9 million) between August and October, up 30.6 percent from 25.9 billion won a year earlier.

NOACs have driven market attention with better efficacy than warfarin and achieved rapid growth every year particularly since the 2015 expansion of insurance coverage for NOACs in Korea.

Bayer’s Xarelto is leading the NOAC market. The treatment sold 11.8 billion won during the three months, up 21.5 percent from a year earlier. Unlike other rival pharmaceuticals that partner with local firms for sales, Bayer sells the anticoagulant and maintains the No.1 position.

Daichi Sankyo’s Lixiana is not called late comer anymore. Lixiana has been swiftly enlarging its market share especially since Daichi Sankyo selected Daewoong Pharmaceutical as a partner for sales.

Prescriptions of Lixiana between August and October posted 9 billion won, surging 75.7 percent from 5.1 billion won a year earlier.

BMS’ Eliquis is also showing a robust sales growth. Although it gave its No.2 position to Lixiana, Eliquis sold 8.8 billion won in the past three months, up 38 percent from 6.4 billion won a year earlier.

Boehringer Ingelheim’s Pradaxa failed to avoid a sales decline. Selling only 4.1 billion won in the three months, the drug showed the worst performance among all the NOACs.

Compared to 4.6 billion won sales a year earlier, the sales went down by 10.6 percent. Boryung Pharmaceutical is the partner sales firm for Pradaxa.

The differences in sales growth came from small differences of anticoagulants. Xarelto offers better patient convenience with once-daily dosage. Lixiana offers clear guidelines for underweight patients or those with renal function deterioration, making it easier for physicians to prescribe.

Eliquis proved its effectiveness in preventing stroke based on a comparative study AVERROES, which compared the drug with aspirin. Eliquis lowered the mortality risk by 11 percent, compared to the conventional treatment warfarin.

Boehringer Ingelheim tried to recover sales of Pradaxa by emphasizing that it enhanced patient safety with Praxbind Injection. The company introduced the injection, which can be used in urgent situations such as emergency operation, for the first time in Korea. However, sales of Pradaxa failed to make a rebound.

“The NOAC market is one of those where the ranking battle is fierce,” a pharmaceutical source said. “Since the government provided reimbursements, physicians have prescribed more NOACs, and their clinical data is accumulating. Each drugmaker is eager to attract patients who used to take warfarin.”

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