Nuclear medicine is a multidisciplinary field that specializes in radioactive material used for diagnosing and treating various diseases in neurology, endocrine system, cardiology, gastrointestinal system, and cancers. Radiopharmaceuticals comprise of a radioactive tracer that is injected in the patient's body. Later, the gamma-rays are released in the body to display images using the Single-photon Emission Computed Tomography (SPECT) and Positron emission tomography (PET) imaging modalities. Nuclear medicine offer umpteen benefits, including early detection, accurate diagnosis, and detail examination of different diseases compared to conventional imaging methods.
The ongoing advancement in the field of radiopharmaceutical is providing practical insights for studying micro-level physiological activities in cancer proliferation, myocardial perfusion in cardiac arrest, ventilation in lungs in severe pneumonia, thyroid, and parathyroid stimulation in case of hyperthyroidism, and metabolic imaging in case of liver disorders, among others. Thereby, nuclear medicines are extensively used in the R&D activities for developing next-generation therapeutics using radiopharmaceuticals conjugates with antibodies, biologic drugs and peptides, targeted drug deliveries, and dose optimization, among others.
Globally, the prevalence of chronic diseases, such as cardiovascular diseases, cancer, respiratory disorders, neurological disorders, and metabolic disorders, are increasing at a concerning rate. As per the Lymphoma Research Foundation, in the U.S., over 1, 00,000 people are diagnosed with lymphoma every year, and it is the most common cancers among children and adults. According to the Global burden of diseases, cardiovascular diseases is one of the leading cause of death, and about 18 million people died of CVD in 2018, and about 35 million people are suffering from heart-related ailments, which is further boosting the demand for nuclear medicines for both diagnostic and therapeutic purposes. Nuclear medicine, such as Technetium-99m, is witnessing huge demand as it is extensively used in wide applications and medical diagnostic procedures, including identification of the predominant lymph nodes, draining malignant lymphocytes in case of lymphoma, and functional cardiac imaging used for the diagnosis of ischemic heart disease. Similarly, Iodine-131-Sodium Iodide and Strontium-89-chloride are used for the treatment of hyperthyroidism, thyroid cancer, and bone metastatic malignancy.
Nuclear medicines have a shorter biological life (less than one day), which is further impeding the market growth to a certain extent. For the record, the biological half-life of nuclear medicines is the time taken to decrease the pharmaceutical's concentration by 50 % of its full concentration in a given tissue, organ, or body. For instance, Technetium 99m is used in Single-photon Emission Computed Tomography (SPECT) preparations and has to be used within less than 12 hours. Similarly, Fluorine-18 used in Positron Emission Tomography (PET), has to be used in 109 minutes. Lastly, Indium-111 nuclear medicine used for white blood cell scans, to search for hidden infections, has a half-life of just 99 minutes.
In the last few years, the demand for nuclear medicines have been witnessing a significant surge due to its widespread application in diagnosis and treatment of various diseases. Additionally, umpteen market players are taking measures to strengthen their distribution network of nuclear medicines. For instance, Jubilant Pharma signed a collaboration agreement with many distribution networks established in the U.S. to ensure a steady and long term supply of nuclear medicines. Similarly, Curium Pharma is heavily investing in the establishment of its own logistics and distribution network to deliver nuclear medicines across the globe. Recently, Lantheus Medical Imaging collaborated with Mallinckrodt plc to develop onsite technetium generators using Mo 99 radioisotope. In the U.S., the government is actively working to expedite the supply of nuclear medicines in the market and has formulated several acts for the same, including the American Medical Isotopes Production Act of 2011 and the U.S. Nuclear Regulatory Commission. All of the above mentioned activities are successfully bridging the gap between the demand and supply of nuclear medicines, which is further boosting the market growth.
In the early 1990s, the adoption of nuclear medicines was at a nascent stage in the healthcare sector compared to other drug products. However, today, it is gaining momentum in the demand and adoption due to the advancements and improvements in diagnosis and treatment in the field of oncology and neurology, which is further offering new growth opportunities to the market players. In addition, the rapid technological advancement in nuclear imaging techniques, such as PET, SPECT, CT, MRI, and other radiological modalities, is fueling the market growth. For instance, the use of Gallium 67 in the SPECT scan has increased the sensitivity of detection from 48 % to 89% in the case of lymphoma, and from 50% to 80% in case of chronic infections. Similarly, the development of cadmium zinc telluride detectors in SPECT systems is offering better spatial resolution and sensitivity with a lower use of radioisotopes for the detection of coronary artery diseases.
The global nuclear medicines market is consolidated with the presence of leading players that are arduously working to increase the product launches and are heavily investing in the R&D activities to attend to the growing demand for efficient diagnosis and treatments, which is further boosting the market growth. For instance, in January 2018, Advanced Accelerator Applications launched its first-ever FDA approved peptide receptor nuclear medicine therapy for the treatment of gastroenteropancreatic neuroendocrine tumors, named Lutathera®. Similarly, Norgine B.V launched the next generation nuclear medicine, named Lymphoseek, which is designed for targeted therapy in various oncological treatments, such as breast cancer, squamous cell carcinoma, and head and neck carcinomas.
The global nuclear medicines market is segmented into type and applications.
The nuclear medicines market is bifurcated into diagnostic nuclear medicine and therapeutic nuclear medicines. The diagnostic nuclear medicine segment holds the largest market share and is estimated to grow at a considerable pace during the forecast period. This can be attributed to the advancement in diagnostic imaging, such as capturing 3D images, accelerated processing speed of devices, and automation in working. The therapeutic segment is projected to grow rapidly due to the development of targeted therapies in the field of cancer and related diseases, such as Ra-223, Iodine-131, Samarium-153, and others used in various oncology and neurological therapies.
The nuclear medicine holds the largest share in the nuclear medicines market owing to the rising adoption of Tc-99m radioisotope in cardiology, oncology, and others. The SPECT nuclear medicines market by applications is segmented into cardiology, oncology, neurology, thyroid, pulmonary, and others. The cardiology market is expected to grow at a significant pace during the forecast period as it is extensively used for a number of cardiac imaging procedures.
The nuclear medicines in PET are expected to grow considerably due to its high accuracy and better resolutions in imaging. The nuclear medicines PET market is divided into oncology, cardiology, neurology, inflammation, and others. The oncology segment is the fastest-growing market due to its growing use in cancer imaging, such as blood related cancers, breast cancer, lung cancer, kidney cancers, and thyroid cancer.
Therapeutic nuclear medicine market is categorized into alpha radiation therapy, beta radiation therapy, and brachytherapy. The alpha radiation therapy is expected to grow at a significant pace. This can be attributed to the increasing adoption of Ra-223 based products and fast regulatory approvals and granting of licenses to the market players. In terms of therapeutic applications, prostate cancer therapies acquired major market share due to its increased incidences and prevalence.
Brachytherapy involves placing nuclear medicine permanently or temporarily in the body in order to destroy cancer-causing cells and damage its malignant capability. As compared with conventional radiation therapies, brachytherapy provides a high dose of tumor-specific radiation and precisely destroys malignant tissues or cells.
North America is holding the largest share in the nuclear medicine market. The region is housing a huge population suffering from cardiovascular diseases and cancer. Additionally, the easy availability of radiopharmaceuticals from local manufacturers, acceptance of nuclear medicine by physicians in various diagnostic and therapeutic procedures, and technological advances are driving the market growth. In 2018, the cardiology application segment held the largest share in the North American market for nuclear medicines due to the rising incidences of cardiovascular disorders, development of new hardware and software designs in SPECT, and high adoption rate of SPECT. The U.S. is dominating the regional market. This can be attributed to the rising focus on domestic manufacturing of various nuclear medicines and radiopharmaceuticals, such as Technetium (Tc 99m). As per the U.S. Department of Energy, about 80 % of the nuclear diagnostic imaging procedures in the U.S. use Technetium 99m (TC-99m) molecule every day. The U.S. FDA has also approved a number of nuclear medicines, including Alpha emitters and radium Ra 223 dichloride injections for the treatment of prostate cancer. Furthermore, the introduction of the new bill, called Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019, will help gain access to more precise and high targeted nuclear medicines for the treatment of various cancers and severe neurological diseases. Besides, the rising demand for patient screening and development of high performance medical diagnostic instruments are driving the market growth. However, in Canada, the Canadian Nuclear Laboratory (CNL) discontinued the function of nuclear reactor that processes molybdenum-99 (Mo-99), the parent isotope of technetium-99 m (Tc-99 m), which is further restraining the market growth to some extent.
Europe nuclear medicines market is witnessing significant growth due to the increasing number of approvals for radioisotopes, such as Tc-99 m, F-18, Ra-223, I-131, and Y-90. Ra-223 is used in Castration-Resistant Prostate Cancer (CRPC) patients with bone metastases, and it is under phase 2 clinical trials. Whereas, I-131 is used for the treatment of Graves' disease and thyroid cancer and is under phase 2 clinical trial. Germany is holding the largest share in the market followed by the U.K., France, Italy, Spain, Russia, and the Rest of Europe. The region is also backed with the immense support of the government who is actively working to develop new techniques to drive the market growth. For instance, in January 2019, the European Regional Development Fund and the Kansen voor’s West foundation sponsored the FIELD-LAB NRG with USD 7.67 million to develop new nuclear medicines for cancer treatment.
In Asia Pacific, the nuclear medicines market is majorly driven by the rising awareness regarding nuclear medicines, increasing prevalence of cancer and cardiovascular diseases, surging healthcare expenditure, and growing applications of SPECT and PET. As per the Cancer Index, about 6.7 million new cases and 4.4 million deaths are estimated every year in the region, which is further boosting the market growth. The regulatory framework in this region ensures the safety and efficacy of nuclear medicines. For instance, in India, the nuclear medicines get approval from the Atomic Energy Regulatory Board (AERB). In China, several regulatory departments like State Food and Drug Administration (SFDA), China Atomic Energy Authority (CAEA), Ministry of Health (MOH), and State Environment Protection Administration (SEPA) approve the nuclear medicine used in the diagnostic and therapeutic applications. In August 2018, Indonesia's National Nuclear Agency (BATAN) and the International Atomic Energy Agency (IAEA), developed a new nuclear medicine (99mTc-ethambutol) for the diagnosis of tuberculosis.
South America is expected to grow at a significant pace during the forecast period. This can be accredited to the increasing demand for nuclear medicines, rising prevalence of chronic diseases, surging healthcare expenditure, growing approvals, and technological advancements. The region is backed with the presence of leading market contributing countries like Brazil and Argentina that are heavily investing in the R&D activities to develop innovative treatment options, which is further boosting the market growth.
The Middle East is emerging in the nuclear medicines market. The UAE is dominating the regional market on account of the rapid technological advancements in the healthcare industry and increasing healthcare expenditure. The diagnostic segment is expected to acquire the largest market share due to the increasing prevalence of diabetes, coronary artery disease, bone metastasis, and Alzheimer’s disease. However, Africa is holding the least share in the market. This can be attributed to the poor healthcare industry, low healthcare expenditure, rising prevalence of cardiovascular diseases and cancer, lack of awareness, and low expenditure power.
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