The domestic market of non-vitamin K antagonist oral anticoagulants (NOAC) grew 30 percent in 2018 compared to a year earlier, industry data showed.

The prescriptions of NOACs went up by about 30 billion won ($26.6 million) in the past year, and the sales of Daichi Sankyo’s Lixiana (edoxaban) amounted to 16 billion won.

According to UBIST data from 2017 to 2019, the total outpatient prescriptions of NOACs amounted to 129.5 billion won last year, up 30.6 percent from 2017.

Physicians had long predicted the rapid growth of NOACs.

Last year, the Korean Heart Rhythm Society said doctors were using NOACs for atrial fibrillation patients actively and that they expected to prescribe the NOACs more. The society also announced the guideline for using NOACs in patients with atrial fibrillation after collecting the latest knowledge and treatment guidelines.

“For patients with atrial fibrillation who begin an anticoagulation therapy to prevent stroke, physicians prefer NOAC to warfarin unless there is a specific contraindication to NOAC,” the society said.

Bayer’s Xarelto (rivaroxaban) is leading the fast-growing local NOAC market. The anticoagulant sold 45.7 billion won last year, up 20 percent from 38.1 billion won in 2017.

Xarelto offers the broadest scope of treatment. In October, Xarelto added an indication for low-dose therapy combined with aspirin to prevent recurrence of cardiovascular events in patients with coronary/peripheral artery disease, for the first time among NOACs.

Daichi Sankyo’s Lixiana is closely chasing Bayer’s Xarelto. Lixiana sold about 34 billion won in 2018, surging 90.3 percent from 17.9 billion won in 2017. Lixiana outpaced BMS’ Eliquis to become the No. 2 player last year.

Lixiana’s success is attributed to a partnership with Daewoong Pharmaceutical for joint promotion and patient convenience with once-daily dosage.

Eliquis (apixaban), in competition with Lixiana for the second place, is taken twice a day.

The Korea Heart Rhythm Society’s guideline states that “adherence to NOAC compliance is essential to maintain the anticoagulant effect, considering the short half-life of the drug.” It also states that “once-daily dosing is better than twice daily in medication compliance of cardiovascular patients.”

Even though BMS’ Eliquis gave out to Lixiana the No.2 position, Eliquis showed robust revenue growth. The blood thinner of BMS sold 33.2 billion won in outpatient prescriptions last year, up 35.6 percent from a year earlier.

Boehringer Ingelheim's Pradaxa (dabigatran) recorded 165 billion won prescriptions, down 11.4 percent from the previous year. Pradaxa was the only NOAC that had a decline in sales, in contrast to the growth of the overall NOAC market.

However, Pradiaxa’s rebound of sales in the second half last year after a steady decline in 2017 was noteworthy. The bounce back of Pradaxa sales resulted from Boehringer Ingelheim's agreement with Boryung Pharmaceutical to jointly sell the drug in July.