Creating a New Market: The Case of Fibromyalgia
Traditional retail, prescription-based market share measures compare a brand's total usage to that of its key competitors—regardless
of the diagnoses for which the products were prescribed. But for products with multiple indications, marketing and sales teams
need this condition-specific level of detail about their brand's performance. In certain situations, competitors will vary
by indication, and the ability to drill down into market share within each diagnosis will provide a truer picture of brand
Fibromyalgia is a chronic, widespread pain condition that has attracted a great deal of attention of late. It is difficult
to diagnose because its symptoms are often confused with those of other pain-related conditions, as well as depression. Despite
the diagnostic uncertainty—and controversy in the media—the FDA, the American College of Rheumatology, and insurers all recognize
fibromyalgia as a legitimate medical condition. According to industry analysts Cowen and Company, fibromyalgia may affect
as many as 12 million Americans—an indication of its major market potential.
Share of Promotions
Although Lilly's anti-depressant Cymbalta (duloxetine) is in active pursuit of approval for use in fibromyalgia, Lyrica (pregabalin)—originally
marketed for two types of neuropathy—remains the only treatment for the condition since is approval in June 2007. The company
is also chasing additional indications for the drug, including epilepsy. (Forest and Cypress are co-developing minalcipran
for fibromyalgia; approval is not expected until 2009.)
Although it represents a major source of the pain market's growth, fibromyalgia today accounts for only a small proportion
of the market's total prescribing (Figure 2). Among primary care doctors, this broadly defined market (from acute to musculoskeletal
to neuropathic diagnoses) is dominated by older products such as opiods, COX-2s, and NSAIDs. Lyrica, by contrast, has generated
shares in the low single digits.
To get a true read on how primary care physicians are treating fibromyalgia—and how they are responding to Pfizer's six-months-old
promotional push for its drug—it's necessary to track market share by diagnosis (Figure 3).
At this level of detail, the picture changes dramatically. Lyrica's share of prescriptions written by primary care doctors
leaps from 2 to 3 percent for all diagnoses (on or off label) to 30 to 35 percent—showing clear potential for market leadership
Share of Prescriptions