Introduction:
Although early-line treatment in the mature hypertension
market is dominated by generics, branded drugs continue to enter and succeed in
this market due to the presence of a sizeable patient population which is not
at their appropriate blood pressure goal and the subsequent requirement for a
multi-faceted treatment approach. This report analyzes U.S. patient-level
claims data to uncover which brands have been most successful in penetrating
early-line treatment, shifts in the use of antihypertensives as patients
progress through lines of therapy, the positioning of angiotensin II receptor
antagonists (AIIRAs), such as Novartis’s Diovan (valsartan), Daiichi Sankyo’s
Benicar (olmesartan), Merck’s Cozaar (losartan), and Bristol-Myers
Squibb/Sanofi-Aventis’s Avapro (irbesartan), as well as Novartis’s renin
inhibitor Tekturna (aliskiren) in hypertension treatment, and patient flow to
fixed-dose combinations (FDCs) from single agent components versus other drugs.
This report couples this analysis with a survey of 151 U.S. cardiologists and
PCPs to determine the relative advantages and disadvantages of leading
therapies, major factors for moving patients to a new line of treatment from
early-line drugs, preferred treatment choices for common comorbid conditions,
and how hypertension treatment is likely to change over the next two years with
the launch of the first generic AIIRA and AIIRA/diuretic combination (losartan
and losartan/hydrochlorothiazide, respectively), thus making it a critical asset
for any brand team looking optimize their drug’s positioning within the
hypertension market.
Questions Answered in This Report:
*
Lines of therapy: Although generic angiotensin-converting
enzyme (ACE) inhibitors are prescribed first line, their side effects (dry cough
in particular) have contributed to the AIIRAs (which also target the
renin-angiotensin-aldosterone system) gaining a foothold in early lines of
therapy.
How much of early-line patient share is devoted to generic versus
branded antihypertensives? What percentages of newly diagnosed patients receive
each AIIRA on each line of therapy? What percentage of patients taking each
first-line drug move to a second-line therapy within a year?
*
Pathways to key therapies: Tekturna, Novartis’s Exforge
(Diovan/amlodipine), and Daiichi Sankyo’s Azor (Benicar/amlodipine) are among
the most recent entrants to the U.S. hypertension market.
What percentage of
patients moving to each of the FDCs in our analysis received one of the drug’s
single-agent components in the previous line of therapy? How are physicians
integrating Tekturna into their treatment of hypertension? What do these
patterns suggest for emerging Tekturna-containing FDCs? How long do patients
stay with their previous drug before moving to an AIIRA, FDC, or Tekturna?
*
Physician behavior: Our analysis of patient-level claims
data suggest that only a minority of the patients moving to an AIIRA as a
non-first-line agent come directly from an ACE inhibitor.
What clinical or
commercial factors prescribe physicians to prescribe Diovan, Cozaar, or Benicar
over another AIIRA? Do these drivers differ between surveyed cardiologists and
PCPs? To what extent to physicians switch within the AIIRA class, and what do
they cite as the leading reasons to change to a new line of treatment?
*
Forecast: Surveyed physicians eagerly anticipate the
launch of the first generic AIIRA, generic formulations of Cozaar in 2010.
How
will cardiologists and PCPs shift their use of ACE inhibitors and the remaining
AIIRAs following the availability of generic losartan? How does physicians’
projections regarding their use of Novartis’s Tekturna/Diovan FDC and
Tekturna/amlodipine FDC by line of therapy compare with their projections for
Exforge, Azor, and other FDCs? What percentage of the prescriptions for the
newer branded beta blockers –GlaxoSmithKline’s Coreg (carvedilol) CR and Forest Laboratories’ Bystolic (nebivilol)—will be in early lines of therapy, broken out by
physician segment?Scope:
Primary research: Quantitative results from our survey
of 151 physicians (76 cardiologists and 75 PCPs):
- Physician opinion on how drug use differs by patient severity.
- Most influential drug attributes when physicians choose between
agents.
- Anticipated changes in the line of therapy in which physicians use
key agents.
Primary patient-level data: Quantitative findings
from our analysis of data covering 61 million lives from 98 geographically
diverse U.S. health plans:
- Quantified lines of therapy analysis showing exact share of each
agent in each line of therapy, including rate of progression between lines and
length of time patients are on each line.
- Progression flowcharts through one year of treatment for newly
diagnosed patients receiving each of the following first line agents: diuretics,
lisinopril, enalapril, ramipril, other ACE inhibitors, atenolol, metoprolol
succinate, metoprolol tartrate, amlodipine, diltiazem, nifedipine,
lisinopril/HCTZ, benazepril/amlodipine, Diovan, Benicar, Avapro, Cozaar, Diovan
HCT, and Benicar HCT.
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: lisinopril, enalapril, ramipril,
Diovan, Avapro, Cozaar, AstraZeneca’s Atacand (candesartan), Boehringer
Ingelheim’s Micardis (telmisartan), Tekturna, Coreg CR, Bystolic, amlodipine,
Pfizer’s Inspra (eplerenone), spironolactone, lisinopril/HCTZ,
benazepril/amlodipine, Diovan HCT, Exforge, Azor, Tekturna HCT.