The Next Pharma Challenge: Treatment Persistence
Pharma’s next growth test is no longer approval, diagnosis or demand. It is whether patients stay on treatment long enough to create clinical and commercial value.
Across obesity, rheumatoid arthritis, ophthalmology and Alzheimer’s, some of pharma’s most closely watched growth areas are long-term treatment categories. Their value depends on whether patients stay on therapy, payers support access and health systems can manage care over time.
The challenge is significant. The World Health Organization estimates that adherence among chronic disease patients in developed countries averages around 50%. Tolerability, cost, injection burden and monitoring requirements can all drive discontinuation, with pressure points varying by therapy area.
That turns treatment continuity into a strategic market question, with direct implications for revenue durability, reimbursement and uptake.
Visiongain Top Takeaways
- Persistence is the new growth test: Chronic therapy markets will be judged by whether patients stay on treatment over time.
- Uptake is only the start: Obesity drugs show why demand must convert into durable use.
- Continuity protects market value: RA shows how lifelong treatment can sustain commercial resilience.
- Burden can cap growth: In ophthalmology and Alzheimer’s, monitoring, visits and administration matter.
- Payers want proof beyond efficacy: Reimbursement will depend on durable outcomes and manageable system costs.
Anti-obesity drugs: demand is clear, durability is the test
The anti-obesity drugs market has become one of pharma’s most closely watched growth stories. Visiongain forecasts the global market to reach US$22.52 billion in 2026, with a projected CAGR of 24.2% to 2036.
The demand case is strong. Obesity is increasingly recognised as a chronic disease linked to type 2 diabetes, cardiovascular disease and wider healthcare costs. GLP-1 receptor agonists and next-generation metabolic therapies have changed clinical expectations, making drug-based weight management a more serious part of ongoing care.
But patient starts alone will not determine market value. Long-term growth will depend on persistence, payer coverage, tolerability and ongoing treatment support beyond the first prescription.
The coverage question is becoming harder to avoid as payers and employers weigh rising uptake against sustained budget exposure. Digital coaching, remote monitoring and patient-support platforms are becoming part of the growth model, although evidence of lasting benefit will matter more than the technology itself.
That is why companies such as Novo Nordisk and Eli Lilly are increasingly competing not only on molecule performance, but on access, patient support and broader treatment infrastructure.
Visiongain Insight: Anti-obesity drugs show why demand alone can overstate market potential. Long-term value will depend on coverage, tolerability, patient support and whether chronic treatment can be sustained beyond the first wave of uptake.
Rheumatoid arthritis: chronic markets depend on continuity
Rheumatoid arthritis (RA) is a useful reminder that not every valuable pharma opportunity is a high-growth story. Some remain important because treatment is continuous, switching is common and disease control matters for decades.
RA requires sustained therapy to prevent joint damage, preserve mobility and reduce disability. Many patients remain on treatment for years, often moving through multiple options as their disease evolves or response changes. That creates a category shaped less by one-off uptake than by continuity of care.
The treatment model has also changed. The focus has moved from symptom control to disease modification, with earlier diagnosis, treat-to-target strategies and durable outcomes carrying greater weight. Biologics remain central in moderate-to-severe disease, while targeted synthetic drugs have added oral alternatives and more flexibility in treatment sequencing, although safety monitoring continues to shape prescribing decisions.
Visiongain forecasts the global rheumatoid arthritis drugs market at US$37.20 billion in 2026, with a projected CAGR of 4.6% to 2036. That growth is modest compared with anti-obesity drugs, but the market’s strength lies in its resilience: lifelong need, recurring treatment, switching behaviour and ongoing demand for advanced therapies.
Visiongain Insight: Rheumatoid arthritis shows why mature chronic disease markets can remain strategically important. Even under biosimilar pressure, value can be sustained through continuity of care, treatment sequencing, patient-friendly delivery and long-term disease control.
Ophthalmology: treatment burden shapes market potential
Ophthalmology illustrates how treatment burden can directly influence market performance.
Ageing populations, rising diabetes prevalence and innovation in retinal disease are moving ophthalmic drugs into a more strategically important category. Visiongain forecasts the global ophthalmic drugs market at US$41.88 billion in 2026, with a projected CAGR of 7.9% to 2036.
The opportunity is not only demographic. Retinal disorders, glaucoma and diabetic eye disease require ongoing management, repeated monitoring and sustained prescription use. In many cases, treatment is not a one-off intervention but a continuing clinical commitment.
Anti-VEGF therapies remain central to retinal care, particularly in age-related macular degeneration, diabetic macular oedema and retinal vein occlusion. Their clinical value is well established, but frequent injections create a real burden for patients, specialists and health systems.
Roche’s Vabysmo and Susvimo illustrate why long-acting retinal therapies are attracting attention, but durability only matters if it reduces service burden without weakening safety, outcomes or payer confidence. In a category facing biosimilar pressure, premium therapies will need to justify their value through evidence of performance and operational benefit.
Visiongain Insight: Ophthalmology shows how treatment burden can limit market potential even when clinical need is clear. In retinal disease, reduced visit frequency is becoming a commercial differentiator only where it supports outcomes, capacity and payer confidence.
Alzheimer’s therapeutics: approval does not solve adoption
Alzheimer’s is one of the clearest examples of a therapy area where scientific progress does not automatically translate into commercial scale.
Visiongain forecasts the global Alzheimer’s therapeutics market at US$6.75 billion in 2026, with a projected CAGR of 18.2% to 2036. The growth potential is significant, but uptake will depend on whether health systems can support complex treatment in routine care.
Disease-modifying therapies require more than regulatory approval. Patients need earlier diagnosis, biomarker confirmation, specialist oversight, safety monitoring and follow-up capacity. For therapies associated with ARIA risk, monitoring is not a minor operational detail. It directly affects physician confidence, payer scrutiny and the speed at which treatment can move beyond specialist centres.
Early uptake has already shown how quickly cost, infusion logistics, scan requirements and safety monitoring can slow adoption, even when clinical need is high.
Eisai and Biogen’s LEQEMBI IQLIK, the subcutaneous maintenance version of lecanemab, shows why home-based delivery is becoming strategically important: it can ease pressure on infusion centres and support treatment continuity if companies can make care easier to sustain. But the core challenge remains structural: therapies must fit into healthcare systems, not just clinical trial settings.
Visiongain Insight: Alzheimer’s shows why approval is only one part of market formation. Commercial success will depend on diagnostic readiness, monitoring capacity, reimbursement design and whether therapies can be delivered safely beyond specialist centres.
Across all four markets, commercial success depends not only on treatment uptake, but on what happens afterwards.
Market Outlook: Persistence Is Becoming a Growth Variable
For pharma, the shift is hard to ignore.
In obesity, rheumatoid arthritis, ophthalmology and Alzheimer’s, the key question is moving beyond demand. It is whether treatment can be maintained in routine care. Coverage discipline, monitoring capacity, delivery format and evidence from clinical practice are becoming important indicators of market performance.
Payer strategies are also becoming more conditional. Prior authorisation, step therapy, patient selection and evidence of durable value are likely to play a greater role in determining which therapies achieve broad uptake.
For pharma companies, the competitive test is changing. Clinical efficacy still matters, but it will not be enough on its own. Products will need to fit the way patients live, the way clinicians work and the way payers judge value over time.
For investors, suppliers and pharma strategists, treatment continuity is becoming a test of forecast quality as much as product performance.
The strongest opportunities will sit with companies that can turn clinical promise into durable use. In chronic treatment categories, follow-through is becoming as important as innovation.
