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PHARMA: More on A-Z, Crestor, statins, heart disease . . .

And in a follow-up to Friday’s post about Crestor, I was alerted to this interview with Astra-Zeneca President David Brennan in which he claims that Crestor’s slower than forecast sales are due to an overabundance of free samples that they’d put into the market and expected (emphasis added by me) concerns about the drugs safety profile following the Baycol withdrawal. However, A-Z still believes that Crestor will get to be 20% of the statin market, and believe that their projections are on track. All of which leads the industry veteran who contributed to the post last week to comment:

    "Talk about a non-denial denial of Crestor’s lagging sales, see the Reuters article below.  I should think that if AZ’s U.S. president, David Brennan, disagreed with the Rx data or if there were any discrepancies in the performance measures, he would clearly make such points.  Not only did he fail to refute the data in the interview, but he says they were expecting this slow uptake. "We knew going into this market, based on our market research, that because of Baycol safety on uptake would be an issue." Strange, but  I don’t recall AZ ever mentioning anything like this before Labor Day!

    Brennan then launched into what I can only consider a diversionary statement about sampling. "AstraZeneca distributed around 100,000 30-day "Reach for Crestor" free sample packs to doctors at the time of launch." This is certainly far short of the 500,000 we heard about earlier, but also suggests a faulty marketing plarelativeve to sampling distribution.  If AZ has 3,000 reps promoting Crestor, the "Reach for Crestor" sample drop provides only 33 sample kits per rep.  If we assume that each rep will drop one sample kit per physician, that means each rep is only sampling 20% of his/her call list (at an average of 150 physicians/rep).  If AZ has 5,000 people on the street to promote Crestor, then they’ve given each rep only 20 sample packs.  Each 4-wk pack is still for only one patient, no matter how many weeks worth of pills are in the sample.  AZ would have been wiser to give out  400,000 1-week sample kits.  The goal consists of getting as many patients as possible to start using the product, not to give a ton of free drugs to fewer patients!

    Brennan goes on to say: "The amount of sampling in general, not just ‘Reach for Crestor’, has increased significantly with our launch. Not only our sampling, but the sampling of our competitors has gone up substantially." I knew someone here was born at night, but I didn’t think it was last night.  What he described here is basic competitive marketing behavior.  When a new product launches, it provides a wakeup call for existing competitors.  They stiffen most of their "spokes on the marketing wheel."

Personally I’m taking a more sympathetic view.  Brennan is a smart guy and he realizes that expectations here have gotten a little our of whack, and that the market needs to see the move to Crestor as evolution rather than revolution.  It’s just a pity that A-Z didn’t try to prepare Wall Street for this before the Crestor launch.  There will be a major DTC effort for Crestor next year, so we’ll see both what that does to sales and how Lipitor and Zocor respond.

Other statin news: Meanwhile theheart.org (reg req’d) reports on a British study which suggests that for patients with heart disease statins are harmful. The study’s author Dr Andrew Clark (University of Hull, UK) commented to heartwire:

    "In heart failure, the fatter you are and the higher your cholesterol, the better off you will be. This raises the possibility that statins may be dangerous in these patients, but I couldn’t state that categorically. We need controlled trials to make such definite statements." But he is not treating his heart-failure patients with statins. "My recommendation at the moment is not to use statins in heart-failure patients. I have no evidence to believe that they are good and quite a lot of suspicious evidence that they are bad," he said.

Of course this is for patients who already have heart disease who are a very small share of the target market for statins.

Theheart.org also has a round up of the letters to the Lancet supporting and opposing its recent anti-Crestor stance.

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Carrie Tucker
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There are a whole lot of reasons to avoid statin drugs! Most health care professionals do not do enough to assist their patients with diet and lifestyle changes before prescribing these harmful drugs. How do I know that? Because I have seen how effective diet and lifestyle changes are at reducing cholesterol levels, and too damn many people are on these drugs. Come on! Let’s try a little harder to support people through those difficult changes. And if you can’t do that, I hope you are supplementing with CoQ10, as statins cause dangerous deficiencies! (not to mention even more dangerous… Read more »