Trends-in-MedicineLynne Peterson,
Senior Writer
Trends-in-Medicine has no financial connections with any pharmaceutical or medical device company. The information and opinions expressed have been compiled or arrived at from sources believed to be reliable and in good faith, but no liability is assumed for information contained in this newsletter.
Copyright© 2003
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Closure Device Update
Summary: The closure market is growing in Europe but relatively flat in the U.S. All U.S. labs questioned already use at least one mechanical device, and most use more than one. St. Jude/Kensey Nash’s AngioSeal and Abbott’s Perclose dominate the mechanical market, and that is likely to continue. However, the field is getting more crowded with new entrants in both mechanical devices and topical products (patches). There is some – but not severe – downward pricing pressure, due in part to the additional competitors. Price is the major factor in the choice of a patch.
Refractive Surgery Update #2
Summary: Slightly more than half the doctors questioned said there was a slowdown in refractive procedures in September after a strong summer, due to a variety of reasons, but mostly to the economy. Interest in wavefront remains high, and doctors are optimistic that it will continue to bring in patients. Wave-front procedures account for an average of 44% of procedures for these surgeons, and that is likely to increase to an average of 64% within a year. Procedure volume for October is looking better than for September, but a slowdown is likely again from Thanksgiving to the end of the year. Refractive surgeons may be busier for the rest of this year than in 2002, but part of this is likely to be due to implantable contact lenses, not LASIK.
Inferior Vena Cava Filters
Summary: The first retrievable filter in the U.S., Bard’s Recovery, has been approved by the FDA, and doctors are very excited about this device, which is likely to take market share from Johnson & Johnson’s OptEase/TrapEase, Boston Scientific’s Greenfield, and Cook’s Tulip. The IVC filter market is small, but retreivable filters should help the makret grow about 16% in each of the next two years. The key problems with retrievable filters are: medical-legal issues, lack of a code for Medicare reimbursement, lack of data, length of implant time, and cost.
The Family Medicine Perspective
Summary: AstraZeneca’s Exanta will fill a niche, but it won’t replace warfarin – it’s too expensive. GlaxoSmithKline’s Wellbutrin XL is quickly replacing Wellbutrin SR but not expanding Wellbutrin use. Forest’s Lexapro is replacing Celexa, but generic citalopram could be a spoiler for Lexapro. Cephalon has a big sell-job ahead to convince family doctors to prescribe Provigil for excessive daytime sleepiness, especially without a sleep lab study. Family doctors are not convinced that Wyeth’s low-dose Prempro is safer than regular Prempro, and it won’t reverse the decline in Prempro use. AstraZeneca’s Crestor is likely to do well with family medicine doctors, who have no safety concerns about it. Use of Schering Plough’s Zetia is expected to more than double over the next year. If Dr Reddy/Par’s amlodipine maleate is priced lower than Novartis’s Norvasc, it will take market share even without an A/B rating. Few doctors are prescribing Watson’s Oxytrol, but they expect use to pickup. There is little interest in MedImmune’s FluMist, with cost the biggest – but not the only -- problem. P&G’s Prilosec OTC is catching on – with patients, doctors and managed care – but doctors are still writing brand prescriptions, though they expect that to get more difficult. HMOs are starting to require that patients take an OTC first and then a generic before a brand.
Transcatheter Cardiovascular Therapeutics
Summary: Boston Scientific’s Taxus drug-eluting stent stole the show at TCT this year. The data was so surprisingly good, that doctors talked about little else. Questions were raised about how the results were computed, but doctors generally found the data persuasive that paclitaxel is safe and effective, and they predicted there would be a quick and dramatic shift from Johnson & Johnson's Cypher to Taxus when it is approved. Data continues to build supporting the value of Cypher, and J&J claimed inventory issues have been resolved. New but early data on drug-eluting stent programs from Abbott, Medtronic and Guidant also looked good.
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