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全球特發性血小板減少紫斑症治療藥物市場：分析 - 按產品、按治療類型、按給藥方法、按分銷管道、按最終用戶、按地區、預測（至 2030 年）

Idiopathic Thrombocytopenic Purpura Therapeutics Market Forecasts to 2030 - Global Analysis By Product, Treatment Type, Mode of Administration, Distribution Channel, End User and By Geography
出版日期: | 出版商: Stratistics Market Research Consulting | 英文 200+ Pages | 商品交期: 2-3個工作天內

價格

預計2023年全球特發性血小板減少紫斑症治療藥物市場規模將達6.491億美元，預測期內複合年成長率為7.04%，2030年將達10.45億美元。

特發性血小板減少紫斑症（ITP）是一種由於免疫系統錯誤地攻擊和破壞血小板而導致血液中血小板數量減少（血小板減少性疾病）的疾病。血小板對於血液凝固至關重要，血小板計數低會導致異常出血和瘀傷。由於患者面臨出血併發症的風險，因此治療包括輸注血小板和服用促進血液凝固和預防出血事件的藥物。

據 WebMD LLC 稱，到 2022 年，ITP 的發生率約為每年每百萬成年人 66 例。兒童平均發生率估計為每年每百萬人 50 例，每年每百萬人報告約 10 例慢性難治性 ITP 新病例。

聯合治療的需求不斷成長

由於療效提高和同時針對多種途徑的能力的推動，市場對聯合治療的需求正在激增。這一趨勢是由對其複雜性的日益了解以及對更全面的治療方法的需求所推動的。聯合治療可提供協同效應，改善患者預後，並越來越受到醫療保健提供者和患者的青睞，從而塑造了治療策略的模式。

治療的副作用

皮質類固醇會導致體重增加、情緒波動和感染風險增加。免疫球蛋白可引起過敏反應和頭痛。由於免疫系統減弱，脾切除術會帶來感染疾病的風險，並增加血栓的風險。治療血小板減少性紫斑症時，監測和適當處理這些副作用非常重要。因此，市面上的皮質類固醇、免疫球蛋白和脾切除術等治療方法可能會帶來副作用。

治療方法進展

血小板生成素受體促效劑(TPO-RA) 等新治療方法已成為增加 ITP 患者血小板數量的有效藥物。此外，Rituximab和福斯塔替尼等免疫調節藥物在治療難治性病例方面顯示出前景。這些進展反映了人們對 ITP 病理生理學的日益了解，並標誌著這种血液疾病標靶治療的發展。因此，這些都是推動市場成長的因素。

昂貴的治療費用

患者常承受免疫球蛋白、皮質類固醇和脾切除術等治療的經濟負擔。這些費用阻礙人們獲得所需的醫療照護和遵循治療計劃。此外，創新治療方法的研發成本導致治療血小板減少性紫斑症的總體成本較高，並為受影響的個體提供醫療保健造成障礙。

COVID-19 的影響：

COVID-19的疫情對血小板減少性紫斑症治療市場產生了重大影響。封鎖和醫療保健優先事項使人們不再關注非緊急症狀，從而影響了診斷和治療。供應鏈中斷導致關鍵藥物短缺，影響病患照護和治療結果。臨床試驗也被推遲，阻礙了新治療方法的開發。然而，醫療準備意識的提高和遠端醫療的採用可能會促進疫情後血小板減少性紫斑症管理的創新和復原力。

預計Rituximab市場將在預測期內成為最大的細分市場

Rituximab市場預計將成為預測期內最大的細分市場。Rituximab單抗是一種針對 B 細胞上 CD20 的單株抗體，已成為治療血小板減少性紫斑症 (ITP) 的有前景的藥物。在治療市場中，Rituximab的作用是調節免疫反應，特別是在常規治療沒有反應的難治性或復發性病例中。它在增加血小板計數和減少出血事件方面的有效性對 ITP 治療的發展做出了重大貢獻。

預計門診手術中心領域在預測期內複合年成長率最高

預計門診手術中心領域在預測期內的複合年成長率最高。門診手術中心透過提供血小板輸注和脾切除術等專門治療和手術在市場上發揮重要作用。這些中心為患者接受護理提供了便利高效的環境，有助於改善患者的治療效果和滿意度。我們擁有先進的技術和熟練的醫療專業人員。

比最大的地區

預計北美在預測期內將佔據最大的市場佔有率。此區域市場的特點是治療選擇多種多樣，包括皮質類固醇、靜脈注射和血小板生成素受體促效劑。這個市場是由意識的提高、醫療技術的進步和患者數量的增加所推動的。此外，持續的研究和開發工作正在幫助擴大該地區的治療選擇並改善患者的治療結果。

複合年成長率最高的地區：

預計亞太地區在預測期內複合年成長率最高。醫療專業人員和患者對醫療保健及其治療方案的認知有所提高，從而實現了早期診斷和治療。製藥公司正在與該地區的醫療保健提供者和研究機構合作開發新治療方法並將其商業化。旨在提高治療功效和安全性的持續研究和開發預計將進一步推動該地區的市場成長。

目錄

第1章執行摘要

第2章 前言

  • 概述
  • 相關利益者
  • 調查範圍
  • 調查方法
    • 資料探勘
    • 資料分析
    • 資料檢驗
    • 研究途徑
  • 研究資訊來源
    • 主要研究資訊來源
    • 二次研究資訊來源
    • 先決條件

第3章市場趨勢分析

  • 促進因素
  • 抑制因素
  • 機會
  • 威脅
  • 產品分析
  • 最終用戶分析
  • 新興市場
  • COVID-19 的影響

第4章波特五力分析

  • 供應商的議價能力
  • 買方議價能力
  • 替代品的威脅
  • 新進入者的威脅
  • 競爭公司之間的敵對關係

第5章全球特發性血小板減少紫斑症治療市場：依產品

  • 抗D免疫球蛋白藥物
  • 皮質類固醇
  • 靜脈注射靜脈注射(IVIG)
  • 血小板生成素受體促效劑（TPO-RA）
  • 其他產品

第6章全球特發性血小板減少紫斑症治療藥物市場：依治療類型

  • 脾切除術
  • Rituximab
  • 免疫抑制劑
  • 其他治療類型

第7章全球特發性血小板減少紫斑症治療市場：依給藥方式分類

  • 口服
  • 靜脈
  • 皮下的
  • 肌肉注射

第8章全球特發性血小板減少紫斑症治療市場：依通路分類

  • 製藥公司
  • 代理銷售
  • 零售藥房
  • 網路藥房

第9章全球特發性血小板減少紫斑症治療市場：依最終用戶分類

  • 門診手術中心
  • 醫院
  • 診所
  • 其他最終用戶

第10章全球特發性血小板減少紫斑症治療市場：按地區

  • 北美洲
    • 美國
    • 加拿大
    • 墨西哥
  • 歐洲
    • 德國
    • 英國
    • 義大利
    • 法國
    • 西班牙
    • 歐洲其他地區
  • 亞太地區
    • 日本
    • 中國
    • 印度
    • 澳洲
    • 紐西蘭
    • 韓國
    • 其他亞太地區
  • 南美洲
    • 阿根廷
    • 巴西
    • 智利
    • 南美洲其他地區
  • 中東/非洲
    • 沙烏地阿拉伯
    • 阿拉伯聯合大公國
    • 卡達
    • 南非
    • 其他中東/非洲

第11章 主要進展

  • 合約、夥伴關係、協作和合資企業
  • 收購和合併
  • 新產品發布
  • 業務擴展
  • 其他關鍵策略

第12章 公司概況

  • Novartis
  • Pfizer
  • Sanofi
  • Amgen Inc.
  • Johnson & Johnson
  • Takeda Pharmaceutical Company
  • GlaxoSmithKline
  • AbbVie
  • Teva Pharmaceutical Industries
  • Merck & Co.
  • Bayer
  • Vertex Pharmaceuticals
  • FUJIFILM Holdings Corporation
  • Olympus Corporation
  • F. Hoffmann-La Roche Ltd
  • Medtronic
  • Eli Lilly and Company
  • GrifolsBiologicals
  • Sun Pharmaceutical Industries Ltd.
Product Code: SMRC25930

According to Stratistics MRC, the Global Idiopathic Thrombocytopenic Purpura Therapeutics Market is accounted for $649.1 million in 2023 and is expected to reach $1045.0 million by 2030 growing at a CAGR of 7.04% during the forecast period. Idiopathic Thrombocytopenic Purpura (ITP) is a disorder characterized by a low platelet count in the blood (thrombocytopenia) due to the immune system mistakenly attacking and destroying platelets. Platelets are crucial for blood clotting, and a reduced platelet count can lead to abnormal bleeding or bruising. Patients are at risk of bleeding complications, so therapies may include platelet transfusions or medications to promote clotting and prevent bleeding episodes.

According to WebMD LLC, in 2022, ITP affected adults at roughly 66 cases per 1,000,000 per year. Children's incidence is estimated to be 50 cases per 1,000,000 per year on average, and about 10 new instances of chronic refractory ITP are reported each year per million people.

Market Dynamics:

Driver:

Rising demand for combination therapies

The market is witnessing a surge in demand for combination therapies, driven by their enhanced efficacy and ability to target multiple pathways simultaneously. This trend is propelled by the growing understanding of the complex nature and the need for more comprehensive treatment approaches. Combination therapies offer synergistic benefits, improved patient outcomes, and are increasingly preferred by healthcare providers and patients alike, shaping the landscape of treatment strategies.

Restraint:

Side effects of treatments

Corticosteroids may cause weight gain, mood swings, and increased risk of infection. Immunoglobulins can lead to allergic reactions or headaches. Splenectomy poses risks of infection due to reduced immune function and increases the risk of blood clots. Monitoring for these side effects and managing them appropriately is crucial in the treatment of thrombocytopenic purpura. Thus, in the market, treatments like corticosteroids, immunoglobulins, and splenectomy can have side effects.

Opportunity:

Advances in treatment options

Novel therapies such as thrombopoietin receptor agonists (TPO-RAs) have emerged as effective agents for increasing platelet counts in ITP patients. Additionally, immunomodulatory drugs like rituximab and fostamatinib have shown promise in managing refractory cases. These developments reflect a growing understanding of ITP's pathophysiology and highlight the evolving landscape of targeted therapies for this hematologic disorder. Hence, these are the factors driving the growth of the market.

Threat:

High cost of treatment

Patients often struggle with the financial burden of therapies, including immunoglobulins, corticosteroids, and splenectomy. These expenses can deter individuals from seeking necessary medical care and adhering to treatment plans. Additionally, research and development costs for innovative therapies contribute to the overall high cost of managing thrombocytopenic purpura, posing a barrier to accessible healthcare for affected individuals.

Covid-19 Impact:

The COVID-19 pandemic significantly impacted the Thrombocytopenic Purpura Therapeutics Market. Lockdowns and healthcare priorities diverted focus from non-emergency conditions, affecting diagnosis and treatment. Supply chain disruptions led to shortages of critical medications, impacting patient care and treatment outcomes. Clinical trials were also delayed, hindering the development of new therapies. However, increased awareness of healthcare preparedness and telemedicine adoption could drive innovation and resilience in managing Thrombocytopenic Purpura in the post-pandemic era.

The rituximab segment is expected to be the largest during the forecast period

The rituximab segment is expected to be the largest during the forecast period. Rituximab, a monoclonal antibody targeting CD20 on B cells, has emerged as a promising therapy for thrombocytopenic purpura (ITP). In the therapeutics market, its role lies in modulating immune response, particularly in refractory or relapsed cases where conventional treatments fail. Its efficacy in increasing platelet counts and reducing bleeding episodes has bolstered its adoption, contributing significantly to the evolving landscape of ITP management.

The ambulatory surgical centers segment is expected to have the highest CAGR during the forecast period

The ambulatory surgical centers segment is expected to have the highest CAGR during the forecast period. They play a crucial role in the market by providing specialized care and procedures such as platelet transfusions and splenectomies. These centers offer a convenient and efficient setting for patients to receive treatment, contributing to improved patient outcomes and satisfaction. With advanced technologies and skilled medical professionals,

Region with largest share:

North America is projected to hold the largest market share during the forecast period. The market in the region is characterized by a diverse range of treatment options, including corticosteroids, intravenous immunoglobulins, and thrombopoietin receptor agonists. This market is driven by increasing awareness, advancements in medical technology, and a growing patient population. Additionally, ongoing research and development efforts contribute to the expansion of treatment modalities and improved outcomes for individuals in the region.

Region with highest CAGR:

Asia Pacific is projected to hold the highest CAGR over the forecast period. Awareness and its treatment options has increased among healthcare professionals and patients, leading to early diagnosis and treatment. Pharmaceutical companies are collaborating with healthcare providers and research institutions in the region to develop and commercialize new treatments. Continuous research and development efforts aimed at improving treatment efficacy and safety are expected to further drive market growth in the region.

Key players in the market

Some of the key players in Idiopathic Thrombocytopenic Purpura Therapeutics market include Novartis, Pfizer, Sanofi, Amgen Inc., Johnson & Johnson, Takeda Pharmaceutical Company, GlaxoSmithKline, AbbVie, Teva Pharmaceutical Industries, Merck & Co., Bayer, Vertex Pharmaceuticals, FUJIFILM Holdings Corporation, Olympus Corporation, F. Hoffmann-La Roche Ltd, Medtronic, Eli Lilly and Company, GrifolsBiologicals and Sun Pharmaceutical Industries Ltd.

Key Developments:

In January 2020, Novartis in association with The ITP Support Association announced the launch of ITP Pocket Log, designed to help people manage and track their ITP on the move, which is available on Google Play and Apple App Store.

In January 2019, GrifolsBiologicals Inc. announced that it has entered into a license agreement with the US-based biotechnology company Rigel Pharmaceuticals to commercialize fostamatinib disodium hexahydrate in all potential future indications in Europe and Turkey.

Products Covered:

  • Anti-D Immunoglobulins
  • Corticosteroids
  • Intravenous Immunoglobulin (IVIG)
  • Thrombopoietin Receptor Agonists (TPO-RA)
  • Other Products

Treatment Types Covered:

  • Splenectomy
  • Rituximab
  • Immunosuppressants
  • Other Treatment Types

Mode of Administrations Covered:

  • Oral
  • Intravenous
  • Subcutaneous
  • Intramuscular

Distribution Channels Covered:

  • Pharmaceutical Companies
  • Distributors
  • Retail Pharmacies
  • Online Pharmacies

End Users Covered:

  • Ambulatory Surgical Centers
  • Hospitals
  • Clinics
  • Other End Users

Regions Covered:

  • North America
    • US
    • Canada
    • Mexico
  • Europe
    • Germany
    • UK
    • Italy
    • France
    • Spain
    • Rest of Europe
  • Asia Pacific
    • Japan
    • China
    • India
    • Australia
    • New Zealand
    • South Korea
    • Rest of Asia Pacific
  • South America
    • Argentina
    • Brazil
    • Chile
    • Rest of South America
  • Middle East & Africa
    • Saudi Arabia
    • UAE
    • Qatar
    • South Africa
    • Rest of Middle East & Africa

What our report offers:

  • Market share assessments for the regional and country-level segments
  • Strategic recommendations for the new entrants
  • Covers Market data for the years 2021, 2022, 2023, 2026, and 2030
  • Market Trends (Drivers, Constraints, Opportunities, Threats, Challenges, Investment Opportunities, and recommendations)
  • Strategic recommendations in key business segments based on the market estimations
  • Competitive landscaping mapping the key common trends
  • Company profiling with detailed strategies, financials, and recent developments
  • Supply chain trends mapping the latest technological advancements

Free Customization Offerings:

All the customers of this report will be entitled to receive one of the following free customization options:

  • Company Profiling
    • Comprehensive profiling of additional market players (up to 3)
    • SWOT Analysis of key players (up to 3)
  • Regional Segmentation
    • Market estimations, Forecasts and CAGR of any prominent country as per the client's interest (Note: Depends on feasibility check)
  • Competitive Benchmarking
    • Benchmarking of key players based on product portfolio, geographical presence, and strategic alliances

Table of Contents

1 Executive Summary

2 Preface

  • 2.1 Abstract
  • 2.2 Stake Holders
  • 2.3 Research Scope
  • 2.4 Research Methodology
    • 2.4.1 Data Mining
    • 2.4.2 Data Analysis
    • 2.4.3 Data Validation
    • 2.4.4 Research Approach
  • 2.5 Research Sources
    • 2.5.1 Primary Research Sources
    • 2.5.2 Secondary Research Sources
    • 2.5.3 Assumptions

3 Market Trend Analysis

  • 3.1 Introduction
  • 3.2 Drivers
  • 3.3 Restraints
  • 3.4 Opportunities
  • 3.5 Threats
  • 3.6 Product Analysis
  • 3.7 End User Analysis
  • 3.8 Emerging Markets
  • 3.9 Impact of Covid-19

4 Porters Five Force Analysis

  • 4.1 Bargaining power of suppliers
  • 4.2 Bargaining power of buyers
  • 4.3 Threat of substitutes
  • 4.4 Threat of new entrants
  • 4.5 Competitive rivalry

5 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market, By Product

  • 5.1 Introduction
  • 5.2 Anti-D Immunoglobulins
  • 5.3 Corticosteroids
  • 5.4 Intravenous Immunoglobulin (IVIG)
  • 5.5 Thrombopoietin Receptor Agonists (TPO-RA)
  • 5.6 Other Products

6 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market, By Treatment Type

  • 6.1 Introduction
  • 6.2 Splenectomy
  • 6.3 Rituximab
  • 6.4 Immunosuppressants
  • 6.5 Other Treatment Types

7 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market, By Mode of Administration

  • 7.1 Introduction
  • 7.2 Oral
  • 7.3 Intravenous
  • 7.4 Subcutaneous
  • 7.5 Intramuscular

8 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market, By Distribution Channel

  • 8.1 Introduction
  • 8.2 Pharmaceutical Companies
  • 8.3 Distributors
  • 8.4 Retail Pharmacies
  • 8.5 Online Pharmacies

9 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market, By End User

  • 9.1 Introduction
  • 9.2 Ambulatory Surgical Centers
  • 9.3 Hospitals
  • 9.4 Clinics
  • 9.5 Other End Users

10 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market, By Geography

  • 10.1 Introduction
  • 10.2 North America
    • 10.2.1 US
    • 10.2.2 Canada
    • 10.2.3 Mexico
  • 10.3 Europe
    • 10.3.1 Germany
    • 10.3.2 UK
    • 10.3.3 Italy
    • 10.3.4 France
    • 10.3.5 Spain
    • 10.3.6 Rest of Europe
  • 10.4 Asia Pacific
    • 10.4.1 Japan
    • 10.4.2 China
    • 10.4.3 India
    • 10.4.4 Australia
    • 10.4.5 New Zealand
    • 10.4.6 South Korea
    • 10.4.7 Rest of Asia Pacific
  • 10.5 South America
    • 10.5.1 Argentina
    • 10.5.2 Brazil
    • 10.5.3 Chile
    • 10.5.4 Rest of South America
  • 10.6 Middle East & Africa
    • 10.6.1 Saudi Arabia
    • 10.6.2 UAE
    • 10.6.3 Qatar
    • 10.6.4 South Africa
    • 10.6.5 Rest of Middle East & Africa

11 Key Developments

  • 11.1 Agreements, Partnerships, Collaborations and Joint Ventures
  • 11.2 Acquisitions & Mergers
  • 11.3 New Product Launch
  • 11.4 Expansions
  • 11.5 Other Key Strategies

12 Company Profiling

  • 12.1 Novartis
  • 12.2 Pfizer
  • 12.3 Sanofi
  • 12.4 Amgen Inc.
  • 12.5 Johnson & Johnson
  • 12.6 Takeda Pharmaceutical Company
  • 12.7 GlaxoSmithKline
  • 12.8 AbbVie
  • 12.9 Teva Pharmaceutical Industries
  • 12.10 Merck & Co.
  • 12.11 Bayer
  • 12.12 Vertex Pharmaceuticals
  • 12.13 FUJIFILM Holdings Corporation
  • 12.14 Olympus Corporation
  • 12.15 F. Hoffmann-La Roche Ltd
  • 12.16 Medtronic
  • 12.17 Eli Lilly and Company
  • 12.18 GrifolsBiologicals
  • 12.19 Sun Pharmaceutical Industries Ltd.

List of Tables

  • Table 1 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Region (2021-2030) ($MN)
  • Table 2 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Product (2021-2030) ($MN)
  • Table 3 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Anti-D Immunoglobulins (2021-2030) ($MN)
  • Table 4 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Corticosteroids (2021-2030) ($MN)
  • Table 5 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Intravenous Immunoglobulin (IVIG) (2021-2030) ($MN)
  • Table 6 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Thrombopoietin Receptor Agonists (TPO-RA) (2021-2030) ($MN)
  • Table 7 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Other Products (2021-2030) ($MN)
  • Table 8 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Treatment Type (2021-2030) ($MN)
  • Table 9 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Splenectomy (2021-2030) ($MN)
  • Table 10 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Rituximab (2021-2030) ($MN)
  • Table 11 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Immunosuppressants (2021-2030) ($MN)
  • Table 12 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Other Treatment Types (2021-2030) ($MN)
  • Table 13 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Mode of Administration (2021-2030) ($MN)
  • Table 14 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Oral (2021-2030) ($MN)
  • Table 15 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Intravenous (2021-2030) ($MN)
  • Table 16 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Subcutaneous (2021-2030) ($MN)
  • Table 17 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Intramuscular (2021-2030) ($MN)
  • Table 18 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Pharmaceutical Companies (2021-2030) ($MN)
  • Table 19 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Distributors (2021-2030) ($MN)
  • Table 20 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Hospital pharmacies (2021-2030) ($MN)
  • Table 21 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Retail pharmacies (2021-2030) ($MN)
  • Table 22 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Online pharmacies (2021-2030) ($MN)
  • Table 23 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By End User (2021-2030) ($MN)
  • Table 24 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Ambulatory surgical centers (2021-2030) ($MN)
  • Table 25 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Hospitals (2021-2030) ($MN)
  • Table 26 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Clinics (2021-2030) ($MN)
  • Table 27 Global Idiopathic Thrombocytopenic Purpura Therapeutics Market Outlook, By Other End Users (2021-2030) ($MN)

Note: Tables for North America, Europe, APAC, South America, and Middle East & Africa Regions are also represented in the same manner as above.