The atrial fibrillation (AF) market across the eight major markets (8MM*) is forecast to decline at a negative compound annual growth rate (CAGR) of 3.2% from $14.5 billion in 2022 to $10.5 billion in 2032, primarily driven by generic sales erosion of the leading novel oral anticoagulants ((NOACs), forecasts GlobalData, a leading data and analytics company.
GlobalData’s latest report, “Atrial Fibrillation: Eight Market Drug Forecast and Market Analysis- Update,” reveals that the market decline will be mainly driven by a drop in sales of the four leading NOACs—Boehringer Ingelheim’s Pradaxa (dabigatran), Bayer’s Xarelto (rivaroxaban), Bristol Myers Squibb’s Eliquis (apixaban), and Daiichi Sankyo’s Savaysa (edoxaban). As a result, NOAC sales across the 8MM are projected to fall from $13.4 billion in 2022 to $7.5 billion in 2032, reflecting a negative CAGR of 5.6%.
Dr Shireen Mohammad, Senior Cardiovascular & Metabolic Disorders Analyst at GlobalData, comments: “Nevertheless, part of these losses will be offset by the introduction and uptake of novel FXI/FXIa inhibitors, which are expected to launch across the 8MM throughout the forecast period 2022-32. In addition, the calcium channel blocker etripamil is anticipated to launch during the forecast period.”
The key opinion leaders (KOLs) interviewed by GlobalData have identified four major unmet needs in the AF market: safer anticoagulants with lower risk of bleeding; anticoagulant therapy for AF patients with severe chronic kidney disease (CKD)/renal failure; safer antiarrhythmic drugs for the maintenance of sinus rhythm; and effective, rapid-acting cardioversion drugs.
According to GlobalData’s analysis, some of these unmet needs may be addressed during the 10-year forecast period, due to the anticipated launch of three late-stage pipeline products: Anthos Therapeutics’ abelacimab, BMS and Johnson & Johnson’s (J&J) milvexian, and Milestone Pharmaceuticals’ etripamil. Milvexian and abelacimab are in the novel anticoagulant drug class targeting the FXI anticoagulation system.
According to a KOL insight and efficacy drug trial readouts, FXI/FXIa inhibitors have the potential to be a safer alternative to NOACs, given their potential to offer hemostasis-sparing anticoagulation. Etripamil is a fast‑acting intranasal calcium channel blocker that can be self‑administered during episodes of symptomatic AF with rapid ventricular response, offering rapid rate control, reduced need for hospital visits, and fewer side effects compared to chronic daily therapies. It could also address unmet needs in AF.
Shireen concludes: “Despite the anticipated decline in overall market value, the US will account for 72% of total global sales by 2032, due to its large patient population and sustained demand for advanced therapies. While increasing competition from generics and pricing pressures are expected to challenge growth globally, opportunities remain for innovation in device-based interventions and next-generation anticoagulants. As the market shifts, stakeholders who adapt to evolving clinical needs and competitive dynamics will be best positioned to capture long-term value.”
*8MM: The US, France, Germany, Italy, Spain, the UK, Canada and Japan
