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Discussions about the easing of pandemic policies have intensified, and for the healthcare sector, investor sentiment has recovered to a certain extent recently
, regardless of the outcome.
In the previous wave of medical equipment discount loan market, endoscopic companies acted as a pioneer, and there is its internal logic
behind it.
According to statistics from Zhongcheng Medical Equipment Research Institute, endoscopes ranked first in the top ten lists of medical equipment purchased in key categories in China in 2021, accounting for nearly 45%.
Behind the wave of endoscopic domestic substitution, there is still a hidden main line - hemp essence drugs
.
.
essence
Endoscopy is an indispensable diagnostic and surgical equipment in general surgery, urology, otolaryngology, orthopedics, gynecology and other departments, for example: whether it is gastroenteroscopy or prostate resection, patients must be seded with anesthetic drugs
.
According to statistics from Zhongcheng Medical Equipment Research Institute, in 2021, third-tier cities will purchase the largest amount of endoscopic equipment, accounting for 27.
10% of the total procurement, which means that the use of endoscopic equipment is no longer the "patent" of public hospitals in first- and second-tier cities, and more hospitals in third- and fourth-tier cities will directly affect the use of endoscopes for diagnosis and treatment and surgery in China, indirectly promoting the volume
of related diagnosis and treatment.
Affected by the epidemic, the reduction of hospital surgery volume is an unavoidable torture, which will directly lead to a decrease
in the use of surgery-related anesthesia drugs.
Some insiders pointed out: "Some hospitals have reduced the number of surgeries by 10%~13% throughout the year during the epidemic, which is already the
norm.
However, this is only the norm in some public hospitals, and the operation of non-public medical institutions is even more worrying: a large number of postponements of surgeries, and outpatient clinics have dropped by 50% or even 70%.
There are two sides to everything, short-term suppression means that the medium and long term is better, as the epidemic prevention policy is gradually relaxed, the suppressed surgical demand and the use of hemp essence drugs will usher in an outbreak
.
essence
Surprisingly, hemp companies have shown strong resilience
during the pandemic.
Taking the leading anesthetic drug Renfu Pharmaceutical as an example, in 2021 and the first half of 2022, the revenue of anesthesia products was 5.
2 billion yuan and 2.
76 billion yuan respectively, a year-on-year increase of 24% and 8%.
01 Hemp essence drugs, healthy competition under strict control
01 Hemp essence drugs, benign competitive essence under strict controlUnder the dual influence of drug procurement and the epidemic, the reason why hemp essence pharmaceutical companies such as Renfu Pharmaceutical and Enhua Pharmaceutical can maintain steady growth is closely related
to the strict control of hemp essence drugs by the state.
In 2005, the State Council promulgated the Regulations on the Administration of Narcotic Drugs and Psychotropic Substances, which are divided into controlled narcotic drugs, Class I psychotropic substances and Class II psychotropic substances, of which narcotic drugs are the strictest and psychotropic substances are slightly weaker
.
Based on the addictive and life-saving characteristics of hemp essence drugs, whether it is research and development, production and sales, every link is highly controlled
by the state.
The APIs and preparations of narcotic analgesics are all produced at designated points, and the distributors are also oligopolies, so which manufacturer enters first, who can occupy the market
.
Therefore, the hemp essence drug market shows the characteristics of few players and a good competitive pattern, and has long been occupied by four major enterprises in the main market share, namely: Hengrui Pharmaceutical, Enhua Pharmaceutical, Renfu Pharmaceutical, and Yangtze River Pharmaceutical
.
.
On the other hand, hemp essence drugs have the characteristics of centralized procurement and immunization, and a number of collective procurement and medical insurance-related policy documents clearly point out that the payment standards for narcotic drugs and Class I psychotropic substances subject to government pricing are determined in accordance with government pricing, and centralized procurement is procured
in accordance with current national regulations.
Narcotic essence drugs are like a tempting and difficult cake in front of new pharmaceutical companies, and new players must solve two major problems while coveting: difficult research and development and innovation, and difficult
breakthrough in market promotion.
1) Slow iteration of new drugs: At present, domestic and even global mainstream clinical hemp essence drugs are old drugs, such as propofol and fentanyl have been approved for marketing
in the 90s of the 20th century.
The reason why there is no new drug replacement for a long time, in addition to strict policy supervision, there are also reasons why
new drugs need to be verified for a long time and the mechanism of action is complex based on drug characteristics.
2) Long market acceptance of new drugs: It is worth noting that the admission of hemp essence drugs is more complex and cautious than that of general drugs, resulting in more energy and resources
required for the early promotion of new drugs than for general drugs.
In addition, because sales channels and academic relationships have been cultivated by the four leading pharmaceutical companies for a long time, new pharmaceutical companies need to withstand the squeeze of these competitors, and at the same time persuade doctors to try new drugs, which requires a lot of time to do market education
in the early stage.
02 Anesthetics and analgesics: explosive products are frequent
02 Anesthetics and analgesics: explosive products are frequentData show that the market size of anesthesia analgesics in China has increased from 13.
6 billion yuan in 2013 to 31.
2 billion yuan in 2019, doubling, with an average annual compound growth rate of 14.
85%, and the market growth rate is second only to oncology drugs
.
.
The rapid growth of the market, in addition to the increase in surgical volume, is also related to
the properties of anesthesia analgesics "associated with tumors".
the properties of anesthesia analgesics "associated with tumors".
”
Cancer pain, which is caused by the sensation caused by the transmission of information to the nerve center in the painful area that needs to be repaired or adjusted, is one of the main causes of pain in cancer patients, and its incidence exceeds 50%, mainly in the advanced stage
of cancer.
Cancer pain greatly affects the patient's quality of life and willingness to
survive.
Such characteristics are destined to give birth to explosive products
in this field.
Recently, Intranet released a list of the top 20 drugs in national sales in 2021, and the first place was neither an antitumor drug nor a chronic disease drug such as diabetes, but Yangtze River Pharmaceutical's dezocine injection, with annual sales of 7.
1 billion, a year-on-year increase of 10%.
Dezocine can rank in the forefront of the top 20 drug sales in the country for many years, in addition to the reasons of market operation, it is related to
its good analgesic effect, safety and wide range of application scenarios.
Dezocine belongs to the second class of psychotropic drugs, and the application scenarios include: 1) anesthesia induction and intraoperative anesthesia assistance; 2) mild to moderate labor pain in postoperative patients (used alone); 3) It can be combined with a variety of other drugs to relieve moderate to severe pain; At the same time, dezocine has the advantages of
mild adverse reactions of respiratory depression, small cardiovascular & gastrointestinal effects, and less abuse reports.
In addition to dezocine, there are many narcotic analgesic drugs with peak sales of more than 2 billion in China, including propofol, fentanyl, dexmedetomidine and so on
.
03 Opportunities for new drugs, the firepower field for the transformation and innovation of traditional pharmaceutical companies
03 Opportunities for new drugs, the firepower field for the transformation and innovation of traditional pharmaceutical companiesThe traditional established giants aiming to transform innovative pharmaceutical companies are unlikely to give up the traditional advantage market of anesthesia and analgesia, and although they have not yet been able to develop "first in class" molecules, a few companies still have the ability to make "Me.
"
better" to improve the ability of
new drugs.
Who would have thought that the most outstanding listed pharmaceutical company with self-developed and layout of anesthesia analgesic innovative drugs is not Hengrui, Renfu and Enhua among the four giants, but Haisco
.
Currently, Haisco holds three major anesthesia analgesic pipelines, including propofol's "Me
Better" cyclopofol has been listed and included in medical insurance, cyclopofol currently has 4 indications listed in China, and there are advantages of "two pieces and five less" (such as faster onset, less dosage, lower injection pain, less respiratory depression, etc.
)
compared with propofol.
In the first half of 2022, cyclopofol sold 1.
5 million bottles, with revenue of 129 million yuan, and has entered more than 900 hospitals, of which 55%
are hospitals above the third class.
More importantly, the first US phase III clinical trial of cyclopofol has reached the preset primary endpoint, and it is expected to grant overseas commercialization authorization in the future, obtaining a good licensing fee and sales share
.
(Source: Southwest Securities)
In addition to cyclopofol, Haisco has two innovative drugs HSK-21542 and HSK-16149 in clinical phase III and production stage, HSK21542 is a peripheral selective opioid receptor agonist with dual effect of analgesia and antipruritic (the first echelon in China), the main indications are postoperative analgesia, colonoscopic analgesia and itching in hemodialysis patients, the current pipeline is in China, the United States, Australia and three places of multi-center clinical trials, the earliest may be listed in 2023-2024; HSK-16149 is a potential me-better drug for pregabalin, indicated for diabetic peripheral neuralgia (estimated 21 million patients in China), compared with pregabalin 16149 has the characteristics of strong analgesia, long-acting analgesia, and small central side effects, which may be more
effective in patients with moderate to severe disease.
The old giants Hengrui Pharmaceutical and Renfu Pharmaceutical are not to be outdone, the former has been approved for new products such as remazolam, the latter has remazolam besylate (introduced) and phosphopropofol disodium disodium
.
The validity of clinical data of both remazolam and remazolam besylate is not inferior to propofol, and the safety is better than that of propofol, but the induction time and induction success rate are slightly inferior to propofol
.
Predicting the future sales trend of the two, Remazolam besylate may be slightly inferior to Hengrui's Remazolam of Hengrui, because: Hengrui was approved earlier and has richer indications, and the competition pattern of remazolam in sample hospitals across the country in 2021 is: Hengrui accounts for 75% and Human Welfare accounts for 25%.
(Source: Southwest Securities)
The indications for phosphopropofol disodium approved by Renfu Pharmaceutical are mainly for the induction of general anesthesia in adults, and from the clinical data, its safety is slightly better than that of propofol, and its effectiveness is not inferior to propofol, which may be between
me-too and me-better of propofol.
In addition, the painless digestive endoscopic diagnosis and treatment indication of Japanese Eisai phosphopropofol disodium was approved for marketing in the United States and withdrawn from the market, and the advantage of phosphopropofol disodium is not obvious, and long-term infusion will cause formaldehyde accumulation (digestive endoscopy indications have a greater impact on sales peak).
From the perspective of the research pipeline, Hengrui Pharmaceutical has two opioid μ receptors and opioid kappa receptors in clinical phase III, and the indications are related to postoperative analgesia; In addition to the marketed remazolam besylate and phosphopropofol disodium that have been marketed, most of the pipelines are in the early clinical and preclinical
stages.
It is also worth mentioning Enhua Pharmaceutical, the company's innovative drug introduced the United States Trevena ocelidin, the drug has been approved for marketing in the United States, the domestic NMPA has accepted the marketing application in January this year, the existing clinical data show that it can be used to relieve postoperative moderate to severe acute pain, and has good safety and tolerability in respiratory and gastrointestinal adverse reactions
.
Enhua Pharmaceutical has also begun to make efforts in self-research, submitting a large number of clinical pipelines, and the indications are concentrated in the field of
neurocentric drugs.
Conclusion: After defense, it is offense, and the hemp essence sector is likely to take the lead in the future counter-offensive, especially the leading enterprises
with strong self-research ability and rich innovation results.
