Brilinta

This is my first post on the new blog. I decided to move away from twitter because of the limited nature of the way you can post. Most of the topics I am interested in require more than a few words.

As the topic of my first post I chose to discuss Brilinta the new anti-coagulant that BMS and AZ have developed. It appears to be one of the few possible block busters out there.

The landmark PLATO (http://www.astrazeneca.com/media/latest-press-releases/brilinta-plato?itemId=5837126) study has been spitting out data at the ECS and the AHA over the past months and now would be a good time to see if all the fuss is warranted.

On face value it beat plavix hands down. Much better outcomes with the same incidence of bleeding side effects. And with plavix beset by all the PPI issues (http://www.webmd.com/heart-disease/news/20090303/plavix-ppi-combo-risky-for-heart-patients) Brilinta seems to waltz into the market at the right time.

I believe that the reason why it was more effective , was also the reason why the marketing of the medication will end up being an issue. The twice daily dosing and the faster onset of action means that the drug keeps a steadier anti coagulation profile at a lower dose according to my reading of the data. It also means that anti -coagulation will reach its required level earlier for those patients that need it right now, ie heart attacks. The stent and ST elevation MI sub analysis seem to bear out this assumption.

As far as the market is concerned , two issues must be uppermost on the minds of the AZ/BMS guys: 1. Plavix is going generic and 2. The twice daily dosing.

Fortunately its shown to be a lot better than Plavix so when they get to NICE or other clinical effectiveness bodies they will have a good case to argue. Saying that , it would probably be shoe horned into the acute coronary syndromes treatment area. For chronic therapy plavix might still win on price. I really hope AZ/BMS will do a genetic sub study for those that are plavix resistant , because in that group Brilinat has a definite chronic indication, same holds for patients on PPI's.

The twice daily dosing is a red herring to me , ace's have been bd for years and cardiovascular patients tend to be fairly compliant on them. Look to the pharma guys thinking of a combo brilinta / ACE inhibitor as a logical development.

I would also love to see a pre-hospital study comparing brilinta with aspirin with suspected ACS patients. With its quick onset it would be ideal for ambulance personal to give , and lets face it not everyone lives 60mins away from a stent.

So watch this space on how the drug will do. But with AZ firing anyone with the word rep on their nametag , I am not sure how they will be able to spread the message quickly to their prescriber market.

Cheers

Comrade Unk

ps: I get paid squat for what I say , so this my unbiased opinion