Short Bowel Syndrome Market Size, Share & COVID-19 Impact Analysis, By Type (GLP-2, Growth Hormone, Glutamine, and Others), By Distribution Channel (Hospital Pharmacies and Online & Retail Pharmacies), and Regional Forecast, 2022-2029

The short bowel syndrome market size was valued at USD 737.9 million in 2021 and is projected to grow from USD 865.3 million in 2022 to USD 2,213.5 million by 2029, exhibiting a CAGR of 14.4% during 2022-2029. North America dominated the global market with a share of 80.89% in 2021.

Based on our analysis, the global market exhibited a growth of 26.3% in 2020 as compared to 2019. There is an increase in the prevalence of short bowel syndrome among the general population globally. Based on various regional and national databases, the condition has affected around 15,000 to 20,000 people in the U.S. and EU-5 respectively. The syndrome is associated with intestinal failure, where the patient pool is highly dependent on parenteral support (PS). There is a rise in the number of patients suffering from short Bowel Syndrome Intestinal Failure (SBS-IF), especially in developed countries owing to factors such as higher diagnosis rates. According to the Crohn's & Colitis Foundation, around 7,000 to 8,000 patients in the U.S. were suffering from SBS-IF in 2021.  

Patients suffering from SBS-IF are highly dependent on parenteral support that provides necessary fluids and nutrients. However, comparatively higher costs of treatment and longer duration are factors leading to reduced quality of life of patients. According to the data published by WebMD LLC in 2021, the cost of parenteral support per person is around USD 65,000 to USD 320,000 annually. This along with the long-term use of parenteral support impacts the patient’s quality of life and develops various complications such as liver dysfunction, catheter sepsis, and others. This results in the high adoption of drugs such as GLP-2 drugs that offer various advantages such as increased intestinal absorption and reduced overall parenteral support of the patient.

Currently, there is only one approved GLP-2 drug, Gattex (Revestive) from Takeda Pharmaceutical Company Limited. However, ongoing clinical studies on GLP-2 drugs with more advanced benefits developed by various biotechnology companies are further anticipated to increase the adoption of these drugs during the forecast period. The benefits include improved dosing frequencies, along with clinically proven efficiency of drugs to treat patients with renal failure, among others.

• In September 2022, Zealand Pharma A/S announced positive results from a phase 3 trial of Glepaglutide for treatment of short bowel syndrome. Glepaglutide is the potential best-in-class long-acting GLP-2 analog. The candidate has distinct advantages over Teduglutide, including once-weekly dosing and a longer half-life.

COVID-19 IMPACT 

Gastrointestinal Complications due to COVID-19 Positively Impacted the Market

Several studies have shown that coronavirus can affect the digestive system leading to various gastrointestinal complications. The SARS-CoV-2 virus attaches to the angiotensin-converting enzyme 2 (ACE-2) in the intestine affecting the digestive system.

• According to the data published by UpToDate, Inc., in 2021, it was estimated that one-third of patients who are critically ill from COVID-19 developed gastrointestinal complications.

The SARS-CoV-2 infection caused several complications, such as inflammatory bowel disease and other gastrointestinal tract infections, in conjunction with several other gastrointestinal disorders. Moreover, COVID-19 affected patients with a severe inflammatory bowel disease condition, which resulted in a higher number of cases of Crohn's disease due to a compromised immune system. This led to a rise in the number of patients suffering from SBS.

During the pandemic, the adoption of parenteral nutrition treatment was declined due to extended hospital stays and various complications associated with this treatment. This has increased the demand for GLP-2-based drugs in the market. All these factors are responsible for the market growth during 2020-2021.

LATEST TRENDS

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Shift from Total Parenteral Nutrition to GLP-2 Drugs to Treat SBS

There has been a preferential shift from Total Parenteral Nutrition (TPN) to GLP-2 drugs owing to the complications caused by the longer use of parenteral nutrition therapy. The risk factors associated with total parenteral nutrition include liver and kidney dysfunction and catheter sepsis. This results in the adoption of innovative drugs to treat this syndrome that helps in reducing the overall parenteral support.

The growing adoption of GLP-2 drugs is due to the effective results shown in increasing intestinal absorption, daily once dosage frequency, among others. This, along with the growing penetration rate of GLP-2 medications for this syndrome with intestinal failure, further increasing the demand for GLP-2 drugs in the market.

This, along with the ongoing clinical trials on GLP-2-based drugs by key players, is further promoting the adoption of GLP-2-based drugs in the market. In January 2021, Hanmi Pharm.Co. Ltd’s. GLP-2 Analog (HM15912) cleared the phase 2 clinical trial.

The factors mentioned above, the strong focus on receiving various product approvals by key players in the market, and the high cost of parenteral nutrition are responsible for the preferential shift to GLP-2 drugs.

SHORT BOWEL SYNDROME MARKET GROWTH FACTORS

Increasing Penetration of GLP-2 Drugs for SBS Intestinal Failure (SBS-IF)

SBS-IF is a rare condition caused among patients with short bowel syndrome. Patients with this condition require a higher frequency of parenteral support. This treatment is usually administered for an average of 5 days per week. However, long-term use of parenteral support is hampering the patient's daily activities, increasing hospitalization rate and complications associated with this treatment leading to the adoption of GLP-2-based drugs in the market.

The increasing penetration of GLP-2 drugs for SBS-IF is observed more in developed countries such as the U.S., Germany, France, etc., than in developing countries. This is due to various factors, including higher preference toward GLP-2 drugs among patients and healthcare providers, higher reimbursement, and availability of drugs.

• Based on internal estimates, around 18% to 20% of all patients suffering from SBS-IF (adults and pediatric) were currently being treated by GLP-2 drugs in the U.S. The penetration is slightly lower in Europe (EU-5 countries), where around 3% to 8% of the population suffering from SBS-IF are currently treated by GLP-2 drugs.


• In 2021, Takeda Pharmaceutical Company Limited launched Gattex/Revestive, a subcutaneous injection for short bowel syndrome, in Japan and received approval from the Ministry of Health, Labor and Welfare.

Furthermore, the penetration of GLP-2 drugs is projected to rise during the forecast period in developed countries. This is due to the various benefits offered by pipeline candidates such as improved dosage frequency, and reduced hospitalization rates, among others.

The factors mentioned above, the rising awareness programs to support patients having this syndrome, and the increasing R&D investments by key players in the market are further driving the market growth.

Rising Awareness Programs to Support Patients Suffering from the Syndrome

The rising incidence of this syndrome in countries such as the U.S., Canada, and the U.K. is increasing the need to develop innovative drug manufacturers to treat this condition. According to the data published by Crohn’s & Colitis Foundation, around 10,000 to 20,000 people have this condition in the U.S.

However, the majority of the population from middle and low-income countries are not aware of this condition due to lack of awareness. This shifted the focus of organizations, such as the Oley Foundation, SBS Foundation, and others, to launch awareness programs to support and educate people suffering from this syndrome.

• For example, the SBS foundation provides the SBSCare program, a CE-certified program aiming to improve patient outcomes through medical and nutritional management.

Moreover, the strong focus of key players on research and development investment to develop innovative drugs further propel the market growth.

RESTRAINING FACTORS

High Treatment Cost to Limit Market Growth

Parenteral nutrition is the most commonly used procedure to treat this syndrome, and the overall treatment cost is expensive. This procedure can be done in hospitals and at-home settings. However, the treatment cost is comparatively less for patients receiving home parenteral nutrition than being treated in hospitals.

Moreover, the huge annual cost of the drugs for treating this condition further limits the adoption of these drugs in the market. For instance, the first approved drug used for treating this syndrome, Gattex/Revestive, is also expensive.

• According to the data published by NCBI in 2019, it was estimated that the annual cost of Gattex/Revestive drug, used for treating this syndrome, is around USD 250,000 to 300,000 per person annually in Europe. The average cost of Gattex in Asia Pacific is around USD 200,000 to 250,000 per person annually.

Also, the lack of reimbursement policies and the limited availability of approved drugs in counties such as India, Africa, and others are further limiting the market growth.

SEGMENTATION

By Type Analysis

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GLP-2 Segment to Dominate Owing to Increased Adoption of Drugs

Based on type, the market has been classified into GLP-2, growth hormone, glutamine, and others.

The GLP-2 segment held a dominant share in 2021. The dominance of the GLP-2 segment is due to a wide range of GLP-2-based pipeline products for short bowel syndrome. Also, the presence of approved products in the market further boosts the segment growth.

• For example, in May 2019, the FDA-approved Gattex to treat children 1 year and older with SBS. Gattex is a GLP-2 analog drug manufactured by Takeda Pharmaceutical Company Limited.

On the other hand, growth hormone is expected to register a higher CAGR during the forecast period. The growth hormone drugs are approved for short-term use in treating this syndrome. Also, the presence of approved drugs such as Zorbtive and the insurance drug coverage benefits offered are further fueling the segment growth during the forecast period.

• In July 2022, the pharmacy benefits program covered Merck KGaA’s Zorbtive, a growth hormone used to treat this condition.

By Distribution Channel Analysis

Preferential Shift of Patients toward Online & Retail Pharmacies to Boost the Segment

By distribution channel, the market is classified into hospitals pharmacies and online & retail pharmacies.

The online & retail pharmacies segment is expected to register the highest CAGR during 2022-2029 and generate the highest revenue among the distribution channel segment in 2021. The dominance is attributed to the growing number of online and retail pharmacies in countries such as the U.S., U.K., India, and others. This, along with the preferential shift of patients toward online platforms, has increased the focus of major players in collaborating with online pharmacies, further propelling the segment growth.

• According to the data published by the Commonwealth Fund in 2021, it was estimated that around 60,000 retail pharmacies are present in the U.S. This provides various opportunities for retail pharmacies to offer innovative drugs for treating this syndrome.

On the other hand, hospital pharmacies are expected to hold a significant share as the rising prevalence of diseases causing short bowel syndrome, such as Crohn's disease, is increasing the demand for advanced drugs to treat such conditions in the market. The key players focus on providing medicines to hospital pharmacies to meet the increasing demand for these advanced drugs.

REGIONAL INSIGHTS

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The market in North America stood at USD 596.9 million in 2021. The presence of a large patient pool adopting advanced drugs and requiring new treatment options is fueling the short bowel syndrome market growth in this region. Also, the extended use of approved drugs to treat both adult and pediatric populations, along with the presence of a wide range of pipeline products, is anticipated to contribute to the market growth in this region during the forecast period.

• In May 2019, Takeda Pharmaceutical Company Limited announced that it received the U.S. FDA approval for GATTEX for children one year and older suffering from this syndrome.

Asia Pacific is expected to register the highest CAGR during the forecast period. The direct presence of major players in the market, the huge R&D investments in developing innovative drugs, and the rising focus on clinical trials on GLP-2-based drugs propel the market growth in this region. However, the rising awareness of rare diseases in countries such as India, Japan, Australia, and others is resulting in the growing demand and need for various treatment options in this region.

• In 2021, Takeda Pharmaceutical Company Limited announced the approval for marketing and distribution of its GLP-2 drug, Gattex, from the Ministry of Health, Labor, and Welfare, Japan.

Europe held the second position in the global market. The direct presence and emergence of new clinical-stage biotechnology companies in this region, mainly focusing on developing innovative drugs and new biologics for treating rare diseases, is fueling European market growth. This along with the various guidelines laid to support patients suffering from this condition.

• For example, according to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines, if the growth factor treatment is taken into account for treating this condition, GLP-2 analog is considered the first line of treatment.

Latin America and the Middle East & Africa regions are expected to account for significant growth during 2022-2029. The rising awareness of rare diseases and the growing need and demand for advanced products in these regions are responsible for the growth during the forecast period. Also, key players are focusing on expanding their distribution network in these regions to meet the growing demand, further fueling the market growth.

• In July 2020, Nestlé Health Science invested USD 50.0 million to establish a manufacturing center in the U.S., which manufactures infant formulas and medical nutrition products such as peptamen. This investment also focuses on distributing the products in Canada, Brazil, Mexico, Australia, and Taiwan.

KEY INDUSTRY PLAYERS

Robust Product and Pipeline Portfolio of Key Competitors to Lead Dominance

In terms of the competitive landscape, the global market is dominated by Takeda Pharmaceutical Company Limited, which accounted for the highest short bowel syndrome market share in 2021. The strong focus on R&D investments for developing and delivering new drugs in the market and entering into mergers and acquisitions with other players to expand their company's presence is responsible for the highest share in the market.

• In June 2021, Takeda Pharmaceutical Company Limited received marketing and manufacturing approval for Gattex/Revestive from the Ministry of Health, Labor and Welfare, Japan.

Also, the emergence of new clinical-stage companies such as VectivBio AG, 9 Meters Biopharma, Inc., Zealand Pharma A/S, and others primarily focus on developing advanced and personalized drugs for treating rare diseases such as short bowel syndrome and graft versus host disease. Moreover, the presence of pipeline products with ongoing clinical studies focuses on gaining market share in the coming years.

• In March 2022, VectivBio AG announced a licensing agreement with Asahi Kasei Pharma Corporation to commercialize and develop apraglutide in Japan, which is used to treat SBS.

LIST OF KEY COMPANIES PROFILED IN SHORT BOWEL SYNDROME MARKET:

• Takeda Pharmaceutical Company Limited (Japan)


• OxThera (Sweden)


• Zealand Pharma A/S (Denmark)


• VectivBio AG (Switzerland)


• Hanmi Pharm Co., Ltd. (South Korea)


• 9 Meters Biopharma, Inc. (U.S.)


• Merck KGaA (Germany)


• Emmaus Medical, Inc. (U.S.)


• Nestlé Health Science (Switzerland)

KEY INDUSTRY DEVELOPMENTS:

• June 2022 – 9 Meters Biopharma, Inc. announced the positive results of the phase 2 clinical study of Vurolenatide in treating this syndrome.

• August 2021 – Zealand Pharma A/S announced the dose administration of Glepaglutide to the first patient in the phase 3b clinical trial for the treatment of short bowel syndrome.


• April 2021 – Hanmi Pharm.Co., Ltd. announced that it received fast-track designation by the U.S. FDA for its HM15912(GLP-2 Analog) used for treating this syndrome.


• November 2018 – The U.S. FDA accepted Shire plc’s application for GATTEX to extend its use on pediatric patients aged 1-17 years suffering from this condition.

REPORT COVERAGE

An Infographic Representation of Short Bowel Syndrome Market

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The global short bowel syndrome market research report provides a detailed analysis of the market. It focuses on key aspects such as leading companies, types, and distribution channels. Besides, it offers insights into the market trends and highlights key industry developments. In addition to the factors mentioned above, the report encompasses several factors that have contributed to the market's growth in recent years.

Report Scope & Segmentation