The Lifecycle of Cipro - Pharmaceutical Executive

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The Lifecycle of Cipro
A cross-functional team of medical, clinical, marketing, and regulatory experts has kept Cipro's lifecycle going for an impressive 17 years--and counting.


Pharmaceutical Executive


The campaign was designed to gain Cipro one point of market share. In practice, it gained two. More important, it taught the team a way to support the product. "We would meet weekly to say, 'What else can we do? What haven't we thought about?" says D'Eugenio. Adds Harris, "If we did not have the data, we would generate it. We would do a study."

What the team learned became a core Bayer strategy. "The study we did for COLT is tiny compared to what we do now," says Kowalsky. "A lot of brands within the Bayer franchise—Levitra and Avelox, for example—learned from COLT."

Below the Belt By 1999, Bayer was ready to rethink its approach to Cipro's main indication: UTI. This was a time when resistance to the TMP-SMX class of anti-infectives was emerging as a true and growing global public health threat. And that created an opportunity.

"Physicians would try Bactrim (trimethoprim/sulfamethoxazole) or penicillin first, then move on to a quinolone like Cipro," says Stahl. "We wanted physicians to think of Cipro more in first-line use. Economic models show that if you are in an area of high levels of resistance, it is more economical for the physician and the patient to start with Cipro first."

The goal was to grow Cipro's UTI use from 48 to 56 percent of the drug's prescriptions. The team treated it like a relaunch, developing an internal icon and logo and conducting a huge Phase IV study of resistance rates. Called Strategic Urology Relaunch and Growth Effort (SURGE), the campaign gave birth to a catchy slogan for Bayer's two quinolones: "Avelox above the belt, Cipro below the belt."

SURGE succeeded in part because the team had already learned some important lessons from previous efforts that aimed to grow their UTI share. One had to do with the disappointing launch, in 1996, of the Cipro Cystitis Pack, a three-day regimen offered in packaging specially designed for women. "We didn't stay true to our branding," says Stahl. "All of a sudden, it was not the standard Cipro blue. As a product manager, I would never again walk away from my branding colors. That is your signature in the marketplace."

There were other issues raised by the pack. Pharmacies were already carrying 250-, 500-, and 750-mg tablets and resisted adding another SKU. Physicians, accustomed to a four- to seven-day course of therapy, balked at the pack's three-day dosing. And because reps were compensated based on dollar volume, they didn't have the proper incentives to push the lower-priced Cystitis Pak. Step by step, by learning from their mistakes along the way, the team mastered the art of managing new formulations and indications.


When the US public became aware of anthrax as a potential threat, Bayer answered the governments call, but it put the company in the controversial position of having to authorize a generic version of Cipro.
Anthrax Attack Some of the most striking—and unexpected—lessons came in the wake of the anthrax attacks of October 2001. Cipro's effectiveness against anthrax had been known since the early 1990s, after the Department of Defense did animal studies to determine its utility. In the first Gulf War, it was used by the troops in Kuwait and Iraq. "Bayer worked continuously with the government to provide Cipro as needed," says Stahl. That paved the way for Bayer's regulatory submission for approval of a new indication. Andy Verderame, director of regulatory affairs, remembers believing that it was a toss-up whether FDA would think it was a good idea or simply laugh in their faces. But, in 2000, Bayer got approval for its anthrax indication.


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