Churg Strauss Syndrome Market: By Drug Class By Route of Administration By Distribution Channel and Region Forecast 2020-2031

Churg Strauss Syndrome Market Size, Share, Growth, Trends, and Global Industry Analysis: By Drug Class (Glucocorticoids, Immunosuppressants, Biologics, Others) By Route of Administration (Oral, Intravenous, Subcutaneous) By Distribution Channel (Hospital Pharmacy, Online Pharmacy, Retail Pharmacy) and Region Forecast 2020-2031

Churg Strauss Syndrome Market size was valued at US$ XX in 2024 and is projected to reach US$ XX million by 2031 at a CAGR of XX% from 2025-2031. Moreover, the U.S. Churg Strauss Syndrome Market is projected to grow significantly, reaching an estimated value of US$ XX Million by 2031.

The market refers to the global healthcare industry focused on the diagnosis, treatment, and management of Churg-Strauss Syndrome (CSS), a rare autoimmune disease characterized by inflammation of blood vessels (vasculitis), leading to damage in various organs.

Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis) Market growth is mainly driven by mounting awareness and diagnosis of the rare autoimmune diseases, advances in immunology and biologic therapy, and greater availability of targeted treatments such as monoclonal antibodies (such as anti-IL-5 therapies such as mepolizumab). Rising research spending and clinical trials into precision and personalized medicine strategies further accelerate market growth. Yet, the market suffers from the paucity of the disease, thus underdiagnosis and misdiagnosis, the costliness of biologic treatments, limited therapy, and the absence of equal knowledge among physicians, which may interfere with premature treatment and equal treatment.

Facts & Figures

  • It is an uncommon disease with an estimated annual incidence of 1-3 per million.
  • Prevalence: 10.7 to 14 per million adults.
  • No Gender Preference: Affects males and females equally.
  • Mean Age of Onset: 38 to 54 years, but cases can occur from as young as 4 to as old as 74.
  • Mortality: If left untreated, mortality rates approach 50% within three months.

Key Developments

  • In August 2023, Vertex Pharmaceuticals made a significant announcement about its Research and Development for therapies of rare autoimmune disorders, reporting potential uses for Churg-Strauss Syndrome.
  • In September 2023, Johnson and Johnson completed the acquisition of a biopharmaceutical firm that specializes in rare diseases, a move set to consolidate their grip on the Churg-Strauss market.
  • In June 2023, Pfizer announced promising clinical trial data against monoclonal antibodies that have the ability to relieve symptoms of this syndrome. Meanwhile, Merck and Co and Roche are expanding their portfolio through experimental drugs designed to address unmet needs in this category.

Churg Strauss Syndrome Market Segmentation

Based on the drug class

  • Glucocorticoids
  • Immunosuppressants
  • Biologics
  • Others

Increasing in the short term, the biologics sub-segment, and more and more mepolizumab, will be the fastest-growing. Mepolizumab is an interleukin-5 (IL-5) monoclonal antibody, a key cytokine that plays a key role in activating and sustaining eosinophils, central to the pathogenesis of CSS. Increasing recognition of the pathogenic function of eosinophils in CSS and the failure of conventional therapy have prompted the identification and utilization of selective biologic agents like mepolizumab. Mepolizumab has been associated with very high levels of efficacy in reducing relapses, improving quality of life, and facilitating glucocorticoid tapering in severe eosinophilic asthma and CSS. As more and more evidence surfaces in support of the use of mepolizumab as a treatment for CSS, its market share will definitely rise at a fast pace over the next few years.

Based on the route of administration

  • Oral
  • Intravenous
  • Subcutaneous

In the Churg Strauss Syndrome (CSS) market, route of administration segmentation is oral, intravenous, and subcutaneous. Oral is the largest sub-segment. Oral drugs, including glucocorticoids (e.g., prednisone) and immunosuppressants (e.g., azathioprine, methotrexate), are the drugs of choice for CSS. They are commonly prescribed because of ease of administration, convenience to the patient, and demonstrated efficacy in controlling the disease. Oral glucocorticoids are especially significant during the induction and maintenance of remission in CSS patients. The ease of availability and cost-effectiveness of oral agents have made their market leaders.

Based on the distribution channel

  • Hospital Pharmacy
  • Online Pharmacy
  • Retail Pharmacy

The hospital pharmacies segment has a strong market share in the Churg-Strauss Syndrome Market owing to the involved complexity of treatment and requirement for guardedly watchful medical monitoring. Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis)-patients may need hospital facilities, particularly during the diagnostic and initiation of treatment phases on high-dose corticosteroids, immunosuppressants, or biologics such as mepolizumab. Inpatient pharmacies are critical to the provision of timely access to these unique drugs, proper storage conditions for biologics, and consultation to clinicians on treatment planning and dosing accuracy. Hospital environments also allow for monitoring patients for side effects and therapeutic effect, which is valuable in the treatment of this life-threatening and infrequent autoimmune disease.

Global Churg Strauss Syndrome Market Summary

Study Period

2025-2031

Base Year

2024

CAGR

X%

Largest Market

North-America

Fastest Growing Market

Asia-Pacific

Churg Strauss Syndrome Market Dynamics

Drivers

The Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis) Market is led by a number of drivers. Enhanced awareness, combined with an increase in diagnostic technology such that this uncommon autoimmune disease is increasingly appropriately diagnosed, allowing early treatment, stimulates the market. Immunology advances and increased utilization of biologic drugs most notably monoclonal antibodies such as mepolizumab (an anti-IL-5 drug) have dramatically enhanced treatment and patient life. Also, favorable policies by the government and increasing research grants for orphan diseases are fueling market growth. Apart from this, technological advances in precision medicine and individualized treatment modalities have provided opportunities for the development of targeted treatments, thereby driving market demand. Further, the growing number of specialty healthcare centers and better access to advanced therapies in developed as well as emerging economies are also affecting the market positively. Increased collaboration among drug firms and research institutions is accelerating the process of new drug development and clinical trials centered around Churg-Strauss Syndrome.

Restraints

The Churg-Strauss Syndrome Market is confronted with several of the limitations that work against its growth potential. It being an orphan condition, it is under-diagnosed or misdiagnosed, thus making treatment complicated and impacting patient outcomes. The exorbitant price of biologic medicines like monoclonal antibodies works against many patients' access to them, especially low- and middle-income countries. Lack of general practitioners' and non-specialist physicians' awareness also prevents early detection and referral critically. Additionally, the absence of large-scale clinical trials and real-world experience in the few available patients also limits the development and approval of new drugs. Complex regulation processes and requirements of prolonged surveillance of safety and efficacy further hinder pharmaceutical companies' entry into this niche market.

 Opportunites

Churg-Strauss Syndrome Market offers numerous promising opportunities for growth and innovation. Global interest in orphan diseases by health authorities and regulators has stimulated the provisions of orphan drug designations and fast-track approval schemes, which has led the pharmaceuticals to make investments in targeted treatments. Advances in immunology, genomics, and biomarkers hold the key to creating patient-specific and precision medicine approaches based on the individual patient profile. Rising markets with improved healthcare infrastructure and better access to specialty care present untapped growth potential for growth in diagnosis and treatment. Moreover, synergy between AI and data analytics in rare disease registries and clinical research can facilitate early diagnosis, more precise patient stratification, and improved treatment strategies, leading to improved disease management and expanding the size of the market.

Trends

The Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis) Market is changing through a series of key trends. One of them is the expanded use of biologic therapies, namely anti-IL-5 monoclonal antibodies such as mepolizumab, which have been very promising in treating eosinophilic inflammation as well as in restricting steroid dependency. Increased interest also lies in personalized medicine, where investigators are looking for genetic and molecular biomarkers to better distinguish among subtypes of disease and personalize therapy. Patient registries and real-world evidence more and more are being used to inform post-approval research and inform clinical decision-making for rare disease. Last, collaborative trials and multinational research networks are increasing with the hope of enabling the rapid development of precision therapies. Digital health technologies such as telemedicine and artificial intelligence-based diagnostic devices are spreading disease surveillance, particularly among low-resource or hard-to-reach groups. Together, the trends project a change towards more precise, more accessible, and more efficient Churg-Strauss Syndrome treatment.

Global Churg Strauss Syndrome Market Segmentation Analysis

Report Benchmarks

Details

Report Study Period

2025-2031

Market CAGR

X%

By Drug Class

  • Glucocorticoids
  • Immunosuppressants
  • Biologics
  • Others

By Route of Administration

  • Oral
  • Intravenous
  • Subcutaneous

By Distribution Channel

  • Hospital Pharmacy
  • Online Pharmacy
  • Retail Pharmacy

By Region

  • North America (U.S., Canada)
  • Europe (Germany, U.K., France, Italy, Russia, Spain, Rest of Europe)
  • Asia-Pacific (China, India, Japan, Australia, Southeast Asia, Rest of Asia Pacific)
  • Latin America (Mexico, Brazil, Argentina, Columbia, Rest of Latin America)
  • Middle East & Africa (GCC, Egypt, Nigeria, South Africa, Rest of Middle East and Africa)

Analyst Review

According to PBI analysts, the Churg Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis) Market will experience steady growth due to increased awareness and improved diagnostics for this rare autoimmune vasculitis. Advances in immunology and wider application of biologic agents, particularly anti-IL-5 monoclonal antibodies like mepolizumab, have significantly improved clinical effectiveness and improved patient quality of life. Heightened investment in research for orphan drugs, benevolent drug policies, and the emergence of personalized medicine are creating a supportive milieu for product development and innovation. North America has the highest market share, with a robust healthcare infrastructure, availability of biologics, and high density of pharmaceutical companies. The Asia-Pacific region is progressively rising due to enhanced access to healthcare, rare disease programs by the government, and expansion of insurance coverage. Despite problems such as costly treatment, underdiagnosis, and low awareness among general practitioners, the market conditions are optimistic with growing global interest in treating orphan diseases, industry collaborative strategies, and advancements in AI-based diagnosis and patient registries.

Key Features of the Report

  • The churg strauss syndrome market provides granular level information about the market size, regional market share, historic market (2020 to 2024) and forecast (2025 to 2031)
  • The report covers in-detail insights about the competitors overview, company share analysis, key market developments, and their key strategies
  • The report outlines drivers, restraints, unmet needs, and trends that are currently affecting the market
  • The report tracks recent innovations, key developments and startups details that are actively working in the market
  • The report provides plethora of information about market entry strategies, regulatory framework and reimbursement scenario
  • The report analyses the impact of socio-political environment through PESTLE Analysis and competition through Porters Five Force Analysis

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Frequently Asked Questions

Churg strauss syndrome market size was valued at US$ XX in 2024 and is projected to reach US$ XX million by 2031 at a CAGR of XX%.

High treatment costs, limited awareness among general practitioners, underdiagnosis or misdiagnosis, and complex regulatory approval processes for new therapies.

Biologics, particularly anti-IL-5 therapies like mepolizumab, are the fastest-growing due to their targeted mechanism and favorable clinical outcomes.

North America, led by the United States, due to strong healthcare infrastructure, availability of advanced treatments, and a high level of disease awareness.

Drugs are distributed through hospital pharmacies, retail pharmacies, and online pharmacies, with hospital pharmacies holding the largest share due to the complexity of treatment.

Author image

Author

Muni Kumar Meravath

Muni Kumar Meravath is a seasoned Healthcare Market Research Analyst with over 6 years of experience in the healthc.....

1.Executive Summary
2.Global Churg Strauss Syndrome Market Introduction 
2.1.Global Churg Strauss Syndrome Market  - Taxonomy
2.2.Global Churg Strauss Syndrome Market  - Definitions
2.2.1.Drug Class
2.2.2. Route of Administration 
2.2.3.Distribution Channel
2.2.4.Region
3.Global Churg Strauss Syndrome Market Dynamics
3.1. Drivers
3.2. Restraints
3.3. Opportunities/Unmet Needs of the Market
3.4. Trends
3.5. Product Landscape
3.6. New Product Launches
3.7. Impact of COVID 19 on Market
4.Global Churg Strauss Syndrome Market Analysis, 2020 - 2024 and Forecast 2025 - 2031
4.1.  Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
4.2.  Year-Over-Year (Y-o-Y) Growth Analysis (%) 
4.3.  Market Opportunity Analysis 
5.Global Churg Strauss Syndrome Market  By Drug Class, 2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
5.1. Glucocorticoids
5.1.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
5.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.1.3. Market Opportunity Analysis 
5.2. Immunosuppressants
5.2.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
5.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.2.3. Market Opportunity Analysis 
5.3. Biologics
5.3.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
5.3.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.3.3. Market Opportunity Analysis 
5.4. Others
5.4.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
5.4.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.4.3. Market Opportunity Analysis 
6.Global Churg Strauss Syndrome Market  By  Route of Administration , 2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
6.1. Oral
6.1.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
6.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.1.3. Market Opportunity Analysis 
6.2. Intravenous
6.2.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
6.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.2.3. Market Opportunity Analysis 
6.3. Subcutaneous
6.3.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
6.3.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.3.3. Market Opportunity Analysis 
7.Global Churg Strauss Syndrome Market  By Distribution Channel, 2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
7.1. Hospital Pharmacy
7.1.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
7.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
7.1.3. Market Opportunity Analysis 
7.2. Online Pharmacy
7.2.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
7.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
7.2.3. Market Opportunity Analysis 
7.3. Retail Pharmacy
7.3.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
7.3.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
7.3.3. Market Opportunity Analysis 
8.Global Churg Strauss Syndrome Market  By Region, 2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
8.1. North America
8.1.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
8.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
8.1.3. Market Opportunity Analysis 
8.2. Europe
8.2.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
8.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
8.2.3. Market Opportunity Analysis 
8.3. Asia Pacific (APAC)
8.3.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
8.3.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
8.3.3. Market Opportunity Analysis 
8.4. Middle East and Africa (MEA)
8.4.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
8.4.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
8.4.3. Market Opportunity Analysis 
8.5. Latin America
8.5.1. Market Analysis, 2020 - 2024 and Forecast, 2025 - 2031, (Sales Value USD Million)
8.5.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
8.5.3. Market Opportunity Analysis 
9.North America Churg Strauss Syndrome Market ,2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
9.1. Drug Class Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
9.1.1.Glucocorticoids
9.1.2.Immunosuppressants
9.1.3.Biologics
9.1.4.Others
9.2.   Route of Administration  Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
9.2.1.Oral
9.2.2.Intravenous
9.2.3.Subcutaneous
9.3.  Distribution Channel Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
9.3.1.Hospital Pharmacy
9.3.2.Online Pharmacy
9.3.3.Retail Pharmacy
9.4.  Country Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
9.4.1.United States of America (USA)
9.4.2.Canada
10.Europe Churg Strauss Syndrome Market ,2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
10.1. Drug Class Analysis  and Forecast  by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
10.1.1.Glucocorticoids
10.1.2.Immunosuppressants
10.1.3.Biologics
10.1.4.Others
10.2.   Route of Administration  Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
10.2.1.Oral
10.2.2.Intravenous
10.2.3.Subcutaneous
10.3.  Distribution Channel Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
10.3.1.Hospital Pharmacy
10.3.2.Online Pharmacy
10.3.3.Retail Pharmacy
10.4.  Country Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
10.4.1.Germany
10.4.2.France
10.4.3.Italy
10.4.4.United Kingdom (UK)
10.4.5.Spain
11.Asia Pacific (APAC) Churg Strauss Syndrome Market ,2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
11.1. Drug Class Analysis  and Forecast  by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
11.1.1.Glucocorticoids
11.1.2.Immunosuppressants
11.1.3.Biologics
11.1.4.Others
11.2.   Route of Administration  Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
11.2.1.Oral
11.2.2.Intravenous
11.2.3.Subcutaneous
11.3.  Distribution Channel Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
11.3.1.Hospital Pharmacy
11.3.2.Online Pharmacy
11.3.3.Retail Pharmacy
11.4.  Country Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
11.4.1.China
11.4.2.India
11.4.3.Australia and New Zealand (ANZ)
11.4.4.Japan
11.4.5.Rest of APAC
12.Middle East and Africa (MEA) Churg Strauss Syndrome Market ,2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
12.1. Drug Class Analysis  and Forecast  by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
12.1.1.Glucocorticoids
12.1.2.Immunosuppressants
12.1.3.Biologics
12.1.4.Others
12.2.   Route of Administration  Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
12.2.1.Oral
12.2.2.Intravenous
12.2.3.Subcutaneous
12.3.  Distribution Channel Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
12.3.1.Hospital Pharmacy
12.3.2.Online Pharmacy
12.3.3.Retail Pharmacy
12.4.  Country Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
12.4.1.GCC Countries
12.4.2.South Africa
12.4.3.Rest of MEA
13.Latin America Churg Strauss Syndrome Market ,2020 - 2024 and Forecast 2025 - 2031 (Sales Value USD Million)
13.1. Drug Class Analysis  and Forecast  by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
13.1.1.Glucocorticoids
13.1.2.Immunosuppressants
13.1.3.Biologics
13.1.4.Others
13.2.   Route of Administration  Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
13.2.1.Oral
13.2.2.Intravenous
13.2.3.Subcutaneous
13.3.  Distribution Channel Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
13.3.1.Hospital Pharmacy
13.3.2.Online Pharmacy
13.3.3.Retail Pharmacy
13.4.  Country Analysis 2020 - 2024 and Forecast 2025 - 2031 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
13.4.1.Brazil
13.4.2.Mexico
13.4.3.Rest of LA
14. Competition Landscape
14.1.  Market Player Profiles (Introduction, Brand/Product Sales, Financial Analysis, Product Offerings, Key Developments, Collaborations, M & A, Strategies, and SWOT Analysis) 
14.2.1.Heron Therapeutics, Inc.
14.2.2.Silvergate  Grifols
14.2.3.GlaxoSmithKline
14.2.4.Roxane Laboratories, Inc.
14.2.5.Hikma Pharmaceutical Corp.
14.2.6.Rx Pharma
14.2.7.Novartis
14.2.8.Schein Pharmaceutical Inc.
15. Research Methodology 
16. Appendix and Abbreviations 

Key Market Players

  • Heron Therapeutics, Inc.
  • Silvergate  Grifols
  • GlaxoSmithKline
  • Roxane Laboratories, Inc.
  • Hikma Pharmaceutical Corp.
  • Rx Pharma
  • Novartis
  • Schein Pharmaceutical Inc.

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