Its All in the Details
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By far, GSK maintained the highest share of details among primary care physicians throughout the height of the Avandia news.
(See "It's All in the Details") The company secured this access either through a "go on the offensive" initiative to counter-detail
the NEJM article, or it was simply granted access based on the inherent desire of physicians to better understand the issue as relayed
to them by a GSK rep. Sound bites recorded by our physician panel included "The rep returned again to discuss the recent news
release on Avandia and the fact that Glaxo is standing behind their product, and offered us an 800 number to call."
Interestingly enough, Takeda may have missed its chance to go on the primary care offensive. Based on the data, it seems the
company may have been waiting to hear the outcome of the June 6 Congressional hearings that addressed Nissen's claims before
launching a market offensive.
But when it came time to speak with endocrinologists, both GSK and Takeda took a strong share of detailing. In the week following
the NEJM publication, Glaxo increased its share of physician-reported details from 27 to 39 percent, while Takeda's grew from 14 to
27 percent. It is likely that the companies dedicated this investment because endocrinologists are typically thought leaders
and have a great influence over other physicians' prescribing behavior.
Doctors also granted access to Merck's Januvia reps, which probably helped drive the increase in that drug's prescribing.
Januvia and Janumet's combined share of details with primary care physicians climbed from 32 to 39 percent in the weeks after
the NEJM publication. It seemed that Merck was able to deploy a "SWAT-like sales force" immediately in light of the uncertainty surrounding
TZDs, and the reps were greeted by physicians because they most likely wanted to hear about alternatives to Avandia.
Meanwhile, by the time Amylin/Lilly reacted to the news, it was too late for Byetta to capture its fair share of physicians'
attention and the patients that were thrown into play.
Market Watch: Will Avandia Regain Its Footing?
The question of the day seems to be just how long Avandia's bad rep will last. To be sure, physician and patient concerns
seem to be dissipating. PCP concerns on the news have moved from May's 4.2 score to 3.6, according to the findings of a second
survey ImpactRx fielded in mid-June. The score for patient concern dropped from 5.9 to 5.2. In a follow-up call, Ruxin even
said that he is "hearing nothing more from patients." Avandia's share of NWRx seems to have stabilized at about 6 percent,
and GSK's share of details has dropped to prior levels. At press time, providers were poised, waiting for word from the FDA
advisory meeting on July 30. FDA's actions coming out of that meeting are the next market test for TZDs.
Currently, strong opinions have been expressed on both sides of the Avandia safety issue. While the New York Times, on June 12, 2007, published an editorial stating FDA should have the power to demand adequate postmarketing studies, the
Wall Street Journal stated a week later that the Avandia fuss is political—not medical—and that FDA already does too much onerous bottlenecking
of new drugs. The scientifically level-headed practitioner will understand that the question of Avandia's safety will be resolved
only with new analyses of existing data and more rigorous studies. This all will take time—much more time than the snapshot
decisions patients make once they hear sound bites of bad safety news.
Richard Altus is the president and CEO of ImpactRx. He can be reached at raltus@impactrx.com
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