Lipitor Losing Loyalty as Cardio Category Cracks Open

Apr 25, 2007
By Pharmaceutical Executive Editors

Doctors and patients are less wedded to cholesterol market leader Lipitor (atorvastatin) than they used to be--a development that competitors might hope to jump on. The Pfizer cash cow has fewer cheerleaders among medical professionals than it did just a year ago, and ever-pickier patients are talking about it less favorably than other statins. Although physicians are still prescribing Lipitor--and a lot of it--analysts believe a wedge has been driven into the cardio category, opening the door for competitors to steal market share.

The "commitment index" from TNS Healthcare, for instance, doesn't track written prescriptions, but its creators do believe it can portend a brand's fortunes. By measuring physicians' attitudes toward a drug, the analysis attempts to determine the likelihood that a brand's high prescribers would be willing to try something else.

With two new generics introduced in the last year alone--and combo creations waiting in the wings--the massive cardio market is increasingly up for grabs. TNS counts only 26 percent of physicians as "committed" to Lipitor, down from 44 percent last year. Meanwhile, commitment to generic simvastatin (the off-patent version of Merck's Zocor) grew nine percent, and Vytorin (the Merck/Schering-Plough combo of simvastatin and ezetimibe) saw a three percent commitment gain.

Lipitor is still growing--about six percent last year--but at only half its 2005 rate, when sales increased 12 percent. Merck reported that last year's Vytorin sales shot up 90 percent over 2005.

"The value that we assign to commitment is that it's actually predictive," said Jonathan Kay, TNS' chief operating officer, US portfolio. "Those physicians who are committed to a brand prescribe two to three times more of that brand."

But Kay cautioned that physicians aren't a homogenous group. For Lipitor, "overall efficacy" was a high driver of commitment, but for Vytorin, committed physicians were split between "quality and value of sales reps visits" and "coverage and reimbursement."

Patients, too, seem less loyal to Lipitor. An analysis of consumer-generated online media found that while the industry's bestseller generated the greatest volume of text (about 62 percent of statin-related web chat), attitudes toward the drug were among the most negative, according to BrandIntel, which conducted the study. Side effects, particularly those related to muscle problems, were among consumers' chief concerns.

AstraZeneca's Crestor (rosuvastatin) generated the most positive opinions, but captured only nine percent of the discussion. BrandIntel, which monitored 130,000 Web sites over the past two quarters, suggested that Crestor and generic simvastatin might be in the best position to capture market share from Lipitor. In fact, Crestor saw sales increase 59 percent over the past year.

"Most discussion relates to firsthand experience with the drug--if the treatment exists, then people will talk about it," said Mark De Paoli, BrandIntel's life-sciences analyst. With so much of the market now in flux, "this is a space that drug companies need to start listening to."

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