This study was conducted to investigate the mechanisms of anaphylaxis in patients with osteoarthritis of the knee and hip after diclofenac etalhyaluronate [product name: JOYCLU® (JCL)] intra-articular injection and to determine the utility of tests to investigate the mechanism involved.

Methods:

In this observational study in Japan, patients aged ≥20 years with knee or hip osteoarthritis who received JCL intra-articular injection experienced anaphylactic symptoms considered related to JCL (‘experienced patients’) or did not experience allergic symptoms considered related to JCL (‘non-experienced patients’). Basophil activation tests (BATs), specific immunoglobulin E (IgE) antibody testing by enzyme-linked immunosorbent assays (ELISAs) or immunochromatographic kit, and genome-wide association studies (GWASs) were conducted using patient blood and saliva.

Results:

Thirteen experienced patients and 14 non-experienced patients were tested. Seven experienced patients tested positive by BAT using diclofenac etalhyaluronate-containing test substances. Diclofenac-specific IgE antibodies were detected in four of seven BAT-positive patients but not in the non-experienced patients. Specific IgE antibody testing by immunochromatographic kit and genome-wide association study showed no clear results.

Conclusions:

These findings suggest that anaphylaxis occurs after JCL administration via an IgE-mediated mechanism and that diclofenac etalhyaluronate may be involved in this mechanism. BAT and diclofenac -specific IgE enzyme-linked immunosorbent assay may be useful tests for investigating the mechanisms of anaphylactic reactions after JCL administration.

2023-01-01·Acute medicine & surgery

Anaphylactic shock due to intra‐articular injection of diclofenac etalhyaluronate sodium: A case report

作者: Uchiyama, Sohta ; Mizutani, Akihito ; Watanabe, Maasa ; Ono Ricart, Yukika ; Yatabe, Tomoaki ; Ito, Takashi

Abstract:

Background:

Anaphylactic shock of diclofenac etalhyaluronate agent can be prolonged and recurrent. However, its reports are rare, and consequently, its method of management remains to be established.

Case Presentation:

A 65‐year‐old woman received an intra‐articular injection of diclofenac and hyaluronate. After 20 min, systemic urticaria and severe hypotension developed after walking. After an intramuscular adrenaline injection, she was transferred to our hospital. Despite administration of continuous noradrenaline and adrenaline, hypotension persisted. Seven hours after the joint injection, 25 mL of knee joint fluid was aspirated under ultrasound guidance. Mobilization was performed 24 h after joint injection. However, urticaria rapidly spread after standing. At 45 and 46 h after joint injection, we confirmed that no symptoms, including urticaria, recurred after walking.

Conclusion:

Anaphylactic shock due to intra‐articular injection of diclofenac etalhyaluronate is prolonged and requires extended observation. Aspiration of joint fluid may be one of the treatment options.

2022-12-01·BMC musculoskeletal disorders3区 · 医学

Diclofenac–hyaluronate conjugate (diclofenac etalhyaluronate) intra-articular injection for hip, ankle, shoulder, and elbow osteoarthritis: a randomized controlled trial

3区 · 医学

ArticleOA

作者: Kano, Kazuyuki ; Ikegami, Hiroyasu ; Nishii, Megumi ; Kumai, Tsukasa ; Seo, Takayuki ; Kubo, Toshikazu

Abstract:

Background:

To evaluate the efficacy and safety of intra-articular injection of diclofenac etalhyaluronate (DF-HA) in patients with osteoarthritis (OA) of the hip, ankle, shoulder, or elbow.

Methods:

In this randomized, placebo-controlled, double-blind study in Japan, Japanese patients aged ≥20 years diagnosed with OA of the hip, ankle, shoulder, or elbow were randomly assigned 1:1 to DF-HA 30 mg or placebo (citric acid-sodium citrate buffered solution). Subjects received three injections of the study drug in each joint cavity every 4 weeks and were assessed for 12 weeks after the first injection. The primary endpoint was the mean change from baseline in a diary-based 11-point numerical rating scale (NRS) for pain over 12 weeks, analyzed for each joint. Treatment-emergent adverse events were recorded, and morphological changes in each joint were evaluated radiographically.

Results:

The study drug (DF-HA vs placebo) was injected into 90, 60, 90, or 50 subjects with OA of the hip, ankle, shoulder, or elbow (46 vs 44, 30 vs 30, 45 vs 45, and 25 vs 25, respectively). The group differences in the mean change from baseline in the pain NRS over 12 weeks were − 0.81 (95% confidence interval: − 1.48 to − 0.13), − 0.07 (− 1.03 to 0.89), 0.15 (− 0.48 to 0.78), and 0.61 (− 0.41 to 1.62) for the hip, ankle, shoulder, and elbow joints, respectively, with statistically significant differences observed only in the hip joint. The change from baseline in the hip joint was greater with DF-HA than placebo at all time points from Weeks 1–12. No clinically significant adverse events or radiographic changes were observed.

Conclusions:

Intra-articularly administered DF-HA for hip OA produced a rapid response and was safe, with analgesia maintained for 12 weeks when administered every 4 weeks.

Trial registration:

JapicCTI-173,678 (First registered date: 21 August 2017).

项与双氯芬酸透明质酸钠相关的新闻（医药）

2022-11-14

·蒲公英Ouryao

NMPA：医用透明质酸钠产品管理类别发布，这些产品按照药品管理

转自：国家药监局编辑：水晶11月14日，国家药监局发布关于医用透明质酸钠产品管理类别的公告（2022年第103号）和《公告》解读。本公告自发布之日起实施。根据不同预期用途（适应症）、工作原理等，医用透明质酸钠（玻璃酸钠）产品按照以下情形分别管理：用于治疗关节炎、干眼症等的产品，按照药品管理。目前透明质酸钠（玻璃酸钠）产品除了在药品、医疗器械应用外，还常用于化妆品、食品等领域，部分产品用途介于药品、医疗器械、化妆品边缘。为更好地指导相关产品管理属性和类别判定，103号公告中增加了涉及透明质酸钠（玻璃酸钠）的边缘产品、药械组合产品管理属性界定原则以及相关医疗器械产品分类原则，明确了相关产品的管理属性和管理类别。根据不同预期用途（适应症）、工作原理等，医用透明质酸钠（玻璃酸钠）产品按照以下情形分别管理：药品管理：用于治疗关节炎、干眼症等的产品，按照药品管理。药械组合产品：对于含有透明质酸钠（玻璃酸钠）的药械组合产品，应当根据产品首要作用方式判定为以药品作用为主或者以医疗器械作用为主的药械组合产品。不提倡药械组合产品添加抗菌成分。对含有抗菌成分的医用敷料产品、含有药物的整形用注射填充物等按下述原则判定： 1.含有抗菌成分的医用敷料产品，应当提供非临床药效学研究和/或临床研究证实产品是否具有抗菌治疗作用。用于判定产品是否具有抗菌治疗作用的非临床药效学研究和/或临床研究及评判标准可参考药品研发相关的非临床和临床技术指导原则。（1）如果非临床药效学研究和/或临床研究证实产品具有明确的抗菌治疗作用，其中，主要通过抗菌治疗作用实现其预期用途的产品判定为以药品为主的药械组合产品；主要通过创面物理覆盖、渗液吸收等作用实现其预期用途的产品判定为以医疗器械为主的药械组合产品。（2）如果非临床药效学研究和/或临床研究未显示产品具有抗菌治疗作用，则产品按照医疗器械管理。不按照药品或者医疗器械管理：1、以涂擦、喷洒或者其他类似方法，施用于皮肤、毛发、指甲、口唇等人体表面，以清洁、保护、修饰、美化为目的的产品，不按照药品或者医疗器械管理。 2、用于缓解阴道干燥的产品（不包括用于阴道创面护理的产品），不按照药品或者医疗器械管理。 3、仅用于破损皮肤、创面消毒的含消毒剂成分的洗液、消毒液、消毒棉片等，不按照药品或者医疗器械管理。其他：经修饰的透明质酸钠（玻璃酸钠）经验证后如相关物理、化学、生物特性与透明质酸钠一致，管理属性和管理类别可参照本公告执行。自公告发布之日起，按照上述管理类别受理医用透明质酸钠（玻璃酸钠）产品的注册申请。已经按照药品或医疗器械受理的注册申请，正在审评、审批的品种，继续按照药品或医疗器械进行审评、审批，符合要求的，核发药品批准文号或医疗器械注册证书。其中，需要改变管理属性或类别的，限定其批准文号或注册证书的有效期截止日期为2024年12月31日。为加强医用透明质酸钠（玻璃酸钠）产品的监督管理，进一步规范相关产品注册（备案），保证公众用药用械安全有效，根据《药品管理法》《医疗器械监督管理条例》相关规定，现就该类产品管理有关事宜公告如下：一、根据不同预期用途（适应症）、工作原理等，医用透明质酸钠（玻璃酸钠）产品按照以下情形分别管理：（一）用于治疗关节炎、干眼症等的产品，按照药品管理。（二）符合以下情形，且不含发挥药理学、代谢学或免疫学作用的药物成分时，按照医疗器械管理，其管理类别不得低于第二类。 1.作为接触镜护理产品应用时，按照第三类医疗器械管理。 2.作为可吸收外科防粘连材料应用时，按照第三类医疗器械管理。 3.作为眼用粘弹剂应用时，按照第三类医疗器械管理。 4.作为注射填充增加组织容积产品应用时，按照第三类医疗器械管理。 5.作为注射到真皮层，主要通过所含透明质酸钠的保湿、补水等作用，改善皮肤状态应用时，按照第三类医疗器械管理。 6.用于修复膀胱上皮氨基葡萄糖保护层应用时，按照第三类医疗器械管理。 7.作为医用敷料应用时，若产品可部分或者全部被人体吸收，或者用于慢性创面，按照第三类医疗器械管理；若产品不可被人体吸收且用于非慢性创面，按照第二类医疗器械管理。 8.作为辅助改善皮肤病理性疤痕，辅助预防皮肤病理性疤痕形成的疤痕修复敷料应用时，按照第二类医疗器械管理。 9.作为口腔溃疡、口腔组织创面愈合治疗辅助材料应用时，按照第二类医疗器械管理。 10.作为体腔器械（不含避孕套）导入润滑剂应用时，按照第二类医疗器械管理。 11.含有透明质酸钠润滑剂的避孕套，按照第二类医疗器械管理。（三）对于含有透明质酸钠（玻璃酸钠）的药械组合产品，应当根据产品首要作用方式判定为以药品作用为主或者以医疗器械作用为主的药械组合产品。不提倡药械组合产品添加抗菌成分。对含有抗菌成分的医用敷料产品、含有药物的整形用注射填充物等按下述原则判定： 1.含有抗菌成分的医用敷料产品，应当提供非临床药效学研究和/或临床研究证实产品是否具有抗菌治疗作用。用于判定产品是否具有抗菌治疗作用的非临床药效学研究和/或临床研究及评判标准可参考药品研发相关的非临床和临床技术指导原则。（1）如果非临床药效学研究和/或临床研究证实产品具有明确的抗菌治疗作用，其中，主要通过抗菌治疗作用实现其预期用途的产品判定为以药品为主的药械组合产品；主要通过创面物理覆盖、渗液吸收等作用实现其预期用途的产品判定为以医疗器械为主的药械组合产品。（2）如果非临床药效学研究和/或临床研究未显示产品具有抗菌治疗作用，则产品按照医疗器械管理。 2.含有局麻药等药物（如盐酸利多卡因、氨基酸、维生素）、主要通过填充增加组织容积的整形用注射填充物，判定为以医疗器械为主的药械组合产品。 3.含有局麻药等药物（如盐酸利多卡因、氨基酸、维生素等）、主要通过所含透明质酸钠的保湿、补水等作用，改善皮肤状态的医疗美容用注射材料，判定为以医疗器械为主的药械组合产品。 4.含有药物的体腔器械（不含避孕套）导入润滑剂，判定为以医疗器械为主的药械组合产品。二、以涂擦、喷洒或者其他类似方法，施用于皮肤、毛发、指甲、口唇等人体表面，以清洁、保护、修饰、美化为目的的产品，不按照药品或者医疗器械管理。用于缓解阴道干燥的产品（不包括用于阴道创面护理的产品），不按照药品或者医疗器械管理。仅用于破损皮肤、创面消毒的含消毒剂成分的洗液、消毒液、消毒棉片等，不按照药品或者医疗器械管理。三、经修饰的透明质酸钠（玻璃酸钠）经验证后如相关物理、化学、生物特性与透明质酸钠一致，管理属性和管理类别可参照本公告执行。四、自公告发布之日起，按照上述管理类别受理医用透明质酸钠（玻璃酸钠）产品的注册申请。五、已经按照药品或医疗器械受理的注册申请，正在审评、审批的品种，继续按照药品或医疗器械进行审评、审批，符合要求的，核发药品批准文号或医疗器械注册证书。其中，需要改变管理属性或类别的，限定其批准文号或注册证书的有效期截止日期为2024年12月31日。六、已获得药品批准文号或医疗器械注册证的产品，需要改变管理属性、管理类别的，原药品批准文号或医疗器械注册证在证书有效期内继续有效；所涉及企业应当按照相应管理属性和类别的有关要求积极开展转换工作，在2024年12月31日之前完成转换。开展转换工作期间原药品批准文号或医疗器械注册证到期的，在产品安全有效且上市后未发生严重不良事件或质量事故的前提下，企业可按原管理属性和类别向原审批部门提出延期申请，予以延期的，原药品批准文号或医疗器械注册证有效期不得超过2024年12月31日。七、已按第一类医疗器械备案的冷敷凝胶、光子冷凝胶、液体敷料、膏状敷料等产品，按照《关于实施〈第一类医疗器械产品目录〉有关事项的通告》（国家药监局通告2021年第107号）和《关于调整〈医疗器械分类目录〉部分内容的公告》（国家药监局公告2022年第25号）有关要求执行。八、各相关企业应当切实落实产品质量安全主体责任，确保上市产品的安全有效。各级药品监督管理部门要加强宣贯培训，切实做好相关产品审评审批和上市后监管工作。九、本公告自发布之日起实施，《关于医用透明质酸钠产品管理类别的公告》（原国家食品药品监督管理局公告2009年第81号）同时废止。国家药监局 2022年11月10日解读：近日，国家药监局发布《关于医用透明质酸钠产品管理类别的公告》（2022年第103号，以下简称103号公告）。现就103号公告出台的背景、修订主要内容说明如下：一、修订背景 2009年，原国家食品药品监督管理局发布《关于医用透明质酸钠产品管理类别的公告》（2009年第81号，以下简称81号公告），指导规范医用透明质酸钠（玻璃酸钠）相关产品的的注册和监管工作。随着科技和产业的快速发展，新产品不断涌现，81号公告已不能完全满足行业和监管需要。因此，国家药监局组织开展了81号公告修订工作。二、修订主要内容说明（一）目前透明质酸钠（玻璃酸钠）产品除了在药品、医疗器械应用外，还常用于化妆品、食品等领域，部分产品用途介于药品、医疗器械、化妆品边缘。为更好地指导相关产品管理属性和类别判定，103号公告中增加了涉及透明质酸钠（玻璃酸钠）的边缘产品、药械组合产品管理属性界定原则以及相关医疗器械产品分类原则，明确了相关产品的管理属性和管理类别。（二）用于治疗膀胱上皮氨基葡萄糖保护层缺损的医用透明质酸钠产品，已按照第三类医疗器械批准上市。该类产品目前无按照药品批准上市的情形，为保持管理的延续性，继续维持原管理属性。（三）当医用透明质酸钠产品用于注射进入皮肤真皮层及以下，作为注射填充增加组织容积产品应用时，如果产品不含发挥药理学、代谢学或免疫学作用的药物成分，则按照第三类医疗器械管理；如果产品含有局麻药等药物（如盐酸利多卡因、氨基酸、维生素），则判定为以医疗器械为主的药械组合产品。（四）当医用透明质酸钠产品作为注射到真皮层，主要通过所含透明质酸钠的保湿、补水等作用，改善皮肤状态应用时，如果产品不含发挥药理学、代谢学或免疫学作用的药物成分，则按照第三类医疗器械管理；如果产品含有局麻药等药物（如盐酸利多卡因、氨基酸、维生素等），则判定为以医疗器械为主的药械组合产品。（五）81号公告中规定“用于治疗……皮肤溃疡等具有确定的药理作用的产品，按照药品管理”，但随着科技的发展和对透明质酸钠认识的加深，目前科研界普遍认为当透明质酸钠用在医用敷料中时，高分子量的透明质酸钠施用于皮肤创面后，其可黏附在皮肤创面表层，并吸附大量水分子，为创面提供湿性的愈合环境，从而有利于创面的愈合，其作用原理主要为物理作用。该类产品在美国和欧盟均按医疗器械管理。因此，103号公告中明确含透明质酸钠的医用敷料，若不含发挥药理学、代谢学或免疫学作用的药物成分，则按照医疗器械管理；若其可部分或者全部被人体吸收，或者用于慢性创面，则按照第三类医疗器械管理；若其不可被人体吸收且用于非慢性创面，则按照第二类医疗器械管理。（六）鉴于辅助改善皮肤病理性疤痕，辅助预防皮肤病理性疤痕形成的疤痕修复材料已列入《医疗器械分类目录》14-12-02疤痕修复材料，按照第二类医疗器械管理。此类产品含有透明质酸钠时，其管理属性和管理类别不作改变。（七）透明质酸钠（玻璃酸钠）一般从动物组织提取或通过微生物发酵法生产，存在一定的潜在风险，第一类医疗器械监管措施难以保障其安全有效性，因此按照医疗器械管理的医用透明质酸钠（玻璃酸钠）产品的管理类别应当不低于第二类。（八）透明质酸钠作为一种保湿补水成分，已在化妆品中应用。以涂擦、喷洒或者其他类似方法，施用于皮肤、毛发、指甲、口唇等人体表面，以清洁、保护、修饰、美化为目的的含透明质酸钠产品，不作为药品或者医疗器械管理。该类产品不应当宣称医疗用途。（九）仅用于破损皮肤、创面消毒的含消毒剂成分的洗液、消毒液、消毒棉片等，不按照药品或者医疗器械管理。（十）经修饰的透明质酸钠经验证后如相关物理、化学、生物特性与透明质酸钠一致，管理属性和管理类别可参照本公告执行。（十一）为明确实施要求，规定了不同情形下注册申请有关事项，对涉及产品管理属性或类别转换的情形，给予了约2年的实施过渡期，以保证平稳过渡。

2022-03-30

·Pharmaceutical Technology

Pipeline therapies promising better disease management for osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease that affects millions of people worldwide and is the most common form of arthritis. It is caused by deterioration of the protective cartilage layer that connects the ends of the bones, and most commonly impacts the hands, hips and knees. OA is more frequently seen in people older than 50 years of age, but younger people can also develop it due to injuries, abnormal joint structure or genetic background. Despite Zilretta’s (triamcinolone acetonide extended-release) and Joycle’s (diclofenac etalhyaluronate) launches in 2017 and last year, respectively, their addition has not provided a novel approach to the management of OA. GlobalData has identified candidates in the late-stage pipeline that have the potential to shift the competitive landscape and treatment paradigm by addressing important unmet needs over the following decade. There are currently 120 pipeline products within the seven major markets (7MM: the US, France, Germany, Italy, Spain, UK and Japan). Of these, eight are expected to launch over the next decade (Phases IIb–III). Therapies targeting OA treatment are distinguished into two categories: pain management medications and disease-modifying osteoarthritis drugs (DMOADs). To date, treatments approved or recommended for OA treatment only include pain management regimens that aim to relieve symptoms without stopping disease progression. Drugs currently in the pipeline, however, are targeting both strategies, with a quarter of the late-stage products being DMOADs. Even though OA is among the most prevalent diseases worldwide, basic unmet needs such as lack of early diagnosis and inability to halt disease progression have yet to be addressed. According to key opinion leaders (KOLs), a significant number of OA patients seek treatment after experiencing pain for months or even years. Lack of knowledge prevents patients from recognising OA-specific symptoms early, which eventually leads to chronic pain and compromises quality of life. In addition, as current OA treatments only target pain and do not prevent disease progression, DMOADs are medications highly anticipated both by physicians and patients. Related Two DMOADs currently in the third phase of clinical studies, namely Kolon TissueGene’s Invossa (NCT03203330, NCT03291470) and Biosplice Therapeutics’ lorecivivint (NCT03928184, NCT04385303), are being studied in moderate-to-severe patients and are competing for first-to-market advantage. KOLs interviewed by GlobalData expect that should they make it to market, physicians will swiftly adopt DMOADs in their treatment paradigm and patients will more actively seek treatment for OA, being hopeful that these treatments will effectively prevent disease progression. OA impacts a large percentage of the population, meaning there is ample opportunity for developers to enter the OA space to address the lack of DMOADs in the market. Developers are striving to be first to market to treat this debilitating joint disease, which has a significant impact on patient quality of life. The first DMOAD to market is likely to grasp a significant market share from current pain management treatments. GlobalData expects the launch of these therapies to shape the OA market and mark a new chapter in the management of OA.

2021-06-22

·GlobeNewswire

New Therapeutic Drugs for Tendinitis Treatment Coming Down

Los Angeles, USA, June 21, 2021 (GLOBE NEWSWIRE) -- New Therapeutic Drugs for Tendinitis Treatment Coming Down the Pipeline There are around 4+ key companies that are developing therapies for Tendinitis. MiMedx has its drug candidate in the most advanced stage. However, the Tendinitis pipeline consists of fewer drugs, so there is an opportunity for different companies to work in this arena and dominate the market. DelveInsight’s “Tendinitis Pipeline Insight” report provides comprehensive insights about 4+ companies and 4+ pipeline drugs in the Tendinitis pipeline landscapes. It comprises Tendinitis pipeline drug profiles, including clinical and non-clinical stage products. It also includes the Tendinitis therapeutics assessment by product type, stage, route of administration, and molecule type and further highlights the inactive Tendinitis pipeline products. Some of the key takeaways from the Tendinitis Pipeline Report Get an overview of pipeline landscape @ Tendinitis Clinical Trials Analysis Tendinitis (also called tendonitis) is an inflammation or irritation of a tendon, a thick cord, which attaches bone to muscle. Tendinitis can occur in almost any area of the body. The most common places are the base of the thumb, elbow, shoulder, hip, knee, Achilles tendon. Tendinitis Emerging Drugs SI-613 is a formulation in which hyaluronic acid and a non-steroidal anti-inflammatory drug (NSAID) are chemically bound utilizing Seikagaku’s proprietary technology. SI-613 was developed to offer pain relief and anti-inflammatory effect by sustained release of NSAID, and the joint function was enhanced by the effect of hyaluronic acid. It is anticipated to offer prompt and sustained relief from severe pain and inflammation associated with osteoarthritis and enthesopathy. The drug is currently in phase II of clinical trials for Tendinitis treatment. MP1032’s mode of action is to accelerate the healing process that allows for MP1032 as a therapeutic for tendinitis before tendinosis develops. In addition, MP1032 could speed up the repair of already damaged tendons and hence also decrease the duration of tendinosis treatments. The drug is currently in phase I of clinical trials for the treatment of tendinitis. dHACM is a micronized dehydrated Human Amnion Chorion Membrane developed by MiMedx for Tendinitis and is currently in the phase III stage of development. AmnioFix is processed using Purion, a unique patented method for placental-based allografts according to the American Association of Tissue Banks (AATB) standards. The product is derived from donated C-sections of live births in the US. The product faces active preservation of the extracellular matrix (ECM), regulatory proteins, and elimination of blood contaminants through a proprietary cleansing process. For an additional level of safety, the product is terminally sterilized. For further information, refer to the detailed report @ Tendinitis Pipeline Therapeutics Scope of Tendinitis Pipeline Drug Insight · Tendinitis Therapies Late-stage (Phase III) · Tendinitis Therapies Mid-stage (Phase II)· Tendinitis Therapies Early-stage (Phase I) · Tendinitis Pre-clinical stage and Discovery candidates · Discontinued and Inactive candidates · Cyclooxygenase inhibitors· Cell replacements, Tissue replacements· Collagen modulators; MicroRNA modulators · Peptides· Monoclonal Antibody· Polymer· Small molecule· Gene therapy · Oral· Parenteral· Intravitreal· Subretinal· Topical · Monotherapy· Combination· Mono/Combination Key Questions regarding Current Tendinitis Treatment Landscape and Emerging Therapies Answered in the Pipeline Report Table of Contents Get a customized pipeline report @ Tendinitis Drugs Pipeline Report Related Reports DelveInsight’s Krabbe Disease Market Insights, Epidemiology and Market Forecast - 2030 report provides a detailed overview of the disease and a depth understanding of historical and forecasted epidemiology. DelveInsight’s Laryngeal Cancer Market Insights, Epidemiology and Market Forecast - 2030 report provides a detailed overview of the disease and a depth understanding of historical and forecasted epidemiology. DelveInsight’s Nosocomial Pneumonia Market Insights, Epidemiology and Market Forecast - 2030 report provides a detailed overview of the disease and a depth understanding of historical and forecasted epidemiology. DelveInsight’s Ornithine Transcarbamylase Deficiency (OTC Deficiency) Market Insights, Epidemiology and Market Forecast - 2030 report provides a detailed overview of the disease. About DelveInsightDelveInsight is a leading Business Consultant, and Market Research firm focused exclusively on life sciences. It supports Pharma companies by providing comprehensive end-to-end solutions to improve their performance. It also provides Healthcare Consulting services comprising credible market analysis that will help accelerate the business growth and overcome challenges with a practical approach.

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