Introduction:
Acute
coronary syndrome (ACS), an umbrella term that encompasses acute ST-elevation
myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI),
and unstable angina (UA), is a leading cause of morbidity and mortality in
Western countries. The use of oral antiplatelets, such as Bristol-Myers
Squibb/Sanofi-Aventis’s multi-blockbuster drug Plavix (clopidogrel), is a
key treatment strategy in this indication. However, despite ongoing
improvements in ACS management, rates of reinfarction and death are high, and
there remains a pressing need for new antithrombotic therapies that can reduce
ischemic complications and mortality.
Scope:
This report explores physician and payer attitudes toward current oral antiplatelet
treatment options, including the most recently launched agent, Daiichi Sankyo/Eli
Lilly’s Effient (prasugrel). How will these opinions shape receptivity toward
the emerging oral antiplatelets in development by AstraZeneca’s Brilinta
(ticagrelor), Merck’s vorapaxar, and Novartis’s elinogrel? These brands are set
to launch in 2011, 2012, and 2014, respectively. We surveyed 57 interventional
cardiologists, 52 non-interventional cardiologists, 50 emergency room
physicians, and 20 managed care organization (MCO) pharmacy directors (PDs) to
achieve the following:
- Determine, for each ACS
diagnosis, the percentage of patients in each risk category. What
percentage of patients has various comorbidities?
- Explore current
treatment strategies, by specialist and by indication. What percentage of
patients is managed by each treatment strategy? What patient share does each
current brand enjoy, by indication and by specialty? How do clinicians choose
among current options? How does the presence of comorbidities affect patient
share?
- Elucidate how well
current brands are differentiated in each specialty. Which agent performs
best across a range of attributes, according to clinicians? What are
clinicians’ priorities for attributes of new brands? What patient-related
factors limit the use of adenosine diphosphate (ADP) receptor antagonists? What
drives choice of Effient over Plavix? How will dosing change over the next 12
months?
- Reveal clinician
attitudes toward emerging brands. What patient share can emerging
antiplatelets expect, by indication? What do clinicians perceive to be the key
advantages and disadvantages of each brand? How will the launch of new brands
impact prescribing of current brands? To what extent will they be used
off-label?
- Gauge how MCOs are positioning antiplatelets on
their formularies and understand how they are using cost controls to guide
prescribing. How will they position novel agents? According to P&T
committee members and MCO PDs, what drives hospital and MCO formulary inclusion
decisions?
- Understand hospital
policies on platelet function tests and pharmacogenomic tests and clinician
attitudes to these tests. How will policies change over the next 12 months?