Lipitor U.S. Sales Tank 70% in 2012 vs 2011!

Lipitor U.S. Sales Tank 70% in 2012 vs 2011!

According to Drugs.com, Lipitor U.S. sales in Q2 of 2012 were only 30% of what they were in Q2 2011 ($579 million vs. $1,949 million, respectively (see chart below; Source: http://www.drugs.com/stats/lipitor).

Meanwhile, sales of Crestor (a competitor anti-cholesterol drug) increased only somewhat during the same period (see chart below; Source: http://www.drugs.com/stats/crestor).

I conclude that most of the loss of Lipitor sales was due to direct competition from generic versions of Lipitor now currently available, which is further proof that Pfizer's "innovative" attempts to stem the generic Lipitor tide has failed (see also "Pfizer Throws In the Lipitor Marketing Towel").

Meet “Ceyockey,” an Astrazeneca Pharma Wikipedian

Meet “Ceyockey,” an Astrazeneca Pharma Wikipedian

The most visible and most accessed example of crowd-sourced “creative commons” information is Wikipedia where “wikipedians” – i.e., people who write and edit the pages for Wikipedia – create drug information pages such as the one about rosuvastatin (“marketed by AstraZeneca as Crestor”).

“Nearly 75% of US physicians going online for professional purposes are visiting Wikipedia for medical information according to Manhattan Research,” says Eileen O'Brien, Director, Search & Innovation at Siren Interactive. “And 36% of US consumers searched for health info on Wikipedia according to Rodale's DTC Study. This is because Wikipedia dominates the search results for health. As Wikipedia plays such a key role, I think it's essential that pharma help to provide accurate information.” O'Brien made her comment in response to the this survey: Should Pharma Edit Wikipedia Articles? You can take the survey here -- afterward you will be able to see a summary of the results to date.

There may in fact be several “wikipedians” responsible for a single page of drug information on Wikipedia. The rosuvastatin page, for example, was edited by over 175 people as of 21 July 2012. The top three “editors” were:

1. “Ceyockey” (who made 35 edits),
2. “Jfdwolff” (who made 29 edits), and
3. “MALvis” (who made 23 edits).

The person who is number 4 on the list with 15 edits is "anon."

Who are these “wikipedians” and what credentials do they have as credible sources of drug information? We may never know who "anon" is, but we have some information about identified contributors.

“Jfdwolff” is a a "Dutch doctor living and working in the United Kingdom." “MALvis” is a US physician, "specializing in preventive, non-invasive and invasive cardiology and internal medicine in San Antonio." Both seem to be well-qualified to write about rosuvastatin, but their Wikipedia profiles tell us nothing about possible conflicts of interest (COI).

“Ceyockey,”  however, does have a COI. He is Courtland Yockey, an “informatics scientist” who lives in Delaware and works for a “top-10 multi-national pharmaceutical company,” according to his profile on Wikipedia.

Yockey has nothing to hide. You can find his Wikipedia profile here,  his LinkedIn page here, his Twitter account  here, and his Facebook page here.

According to his LinkedIn page, the pharmaceutical company that Yockey works for is Astrazeneca, which markets rosuvastatin as CRESTOR.

“I believe that my editing of Wikipedia is generally beneficial,” says Yockey in his Wikipedia profile, “and I have no regrets or concerns about anything that I have or will create or revise here, which is why I am willing to provide my real name.”

Whether or not it is “beneficial” for individual pharma company employees such as Yockey to be editing Wikipedia information about their own company’s products is difficult to know for certain. Transparency, however, is crucial for judging credibility of drug information on Wikipedia. Yockey addressed transparency head on in a straight-forward fashion, although he failed to state unambiguously  in his Wikipedia profile that he works for “Astrazeneca.”

Did Astrazeneca empower Yockey or give him permission to edit Wikipedia pages about AZ drugs? That is, is Yockey an "official" Wikipedia spokesperson appointed by Astrazeneca to perform all Wikipedia article edits on behalf of the company? I doubt it. Yockey's profile specifies that he works on edits from home.

Official pharma employee Wikipedia editors and related issues were discussed during a recent Pharma Marketing Talk podcast titled “Pharma Wikipedians: The Pros and Cons of Pharma Employees Editing Wikipedia Articles” (listen here).

It's possible to determine the exact edits Yockey has made to the Wikipedia rosuvastatin page, but I do not have the time or resources to find that needle in a haystack of thousands of edits Yockey has made to Wikipedia articles over the years. Wikipedia is not user-friendly enough to allow ordinary citizens to ferret out that kind of information, IMHO. For all I know, Yockey could have written or edited the section titled "Debate and criticisms."

Another problem with Wikipedia drug information pages is that they are not consumer-friendly -- i.e., not written at a level that is understandable by non-physicians. The Wikipedia rosuvastatin page, for example, says "as with all statins, there is a concern of rhabdomyolysis, a severe undesired side effect." Unfortunately, the article does not explain what rhabdomyolysis is in layperson terms.

AstraZeneca's Timely CRESTOR Branded Blog Post: Did It Violate Its Own Policy?

AstraZeneca's Timely CRESTOR Branded Blog Post: Did It Violate Its Own Policy?

It's unusual for a pharmaceutical company to mention a product by brand name on its corporate blog. It's even more unusual to mention BOTH the product AND its indication -- because that would be promotion regulated by the FDA. But AstraZeneca (AZ) has done just that on its "AZ Health Connections" corporate blog.

The majority of the post "New CDC data shows drop in number of adults with high cholesterol" submitted by Tom Hushen, AZ's External Communications Manager, talks about CRESTOR, AZ's anti-cholesterol drug. The post may have been ghostwritten for "Dr Philip de Vane, Executive Director of Clinical Development at AstraZeneca," whose name appears at the bottom.

After briefly citing the results of the CDC (Centers for Disease Control) study (see below) in the first paragraph, Hushen dedicates the most of the remaining 309 words of the 377-word post to CRESTOR as in:

"AstraZeneca applauds this progress and we are proud that when diet and exercise alone aren’t enough, prescription medications like CRESTOR® (rosuvastatin calcium) are able to help patients reach their cholesterol goals. In adults, CRESTOR is prescribed along with diet to lower high cholesterol and to slow the buildup of plaque in arteries."

Included in the post is the "fair balance" information required by law:

"CRESTOR is not right for everyone─like people with liver disease or women who are nursing, pregnant or may become pregnant. Tell your doctor about other medicines you are taking. Call your doctor right away if you have muscle pain or weakness; feel unusually tired; have loss of appetite, upper belly pain, dark urine, or yellowing of skin or eyes─these could be signs of rare but serious side effects. See www.CRESTOR.com"

Although this is not earth-shaking or in violation of any law that I know of, it nevertheless is the FIRST time a pharmaceutical company has promoted a prescription drug on its official corporate blog -- ie, talked about the drug's benefits.

It's even more interesting considering the AZ Health Connections "Comment Policy" seems to preclude any comments about specific products:

"We want to make sure AZ Health Connections provides a good experience for all visitors. Therefore, we want to keep the content focused on the specific topics being addressed. Comments that don’t directly relate to AstraZeneca or the topics currently being discussed, or comments or questions about specific products (whether or not AstraZeneca products) or ongoing legal or regulatory matters may not be published or may be removed."

Could it be that what's good for the "goose" (AZ) is not good for the "gander" (everyone else)? It seems that AZ has relaxed its comments policy, at least this one time. As proof of this, I submitted the following comment, which AZ published:

"I am one of those U.S. adults with high cholesterol that is having problems controlling it with just diet and exercise, which I don’t even try to do :-). But I am worried about taking powerful medicines such as CRESTOR because of the side effects that you mention."

AZ published that comment made by this "gander." It is the only comment published so far, so I have no idea if other people have submitted comments that were NOT published. Maybe Tony Jewell, Senior Director of External Communications at AstraZeneca US, will tell us. NOTE: Jewell received the coveted "Pharmaguy Social Media Pioneer Award" in 2011 (see here).

Note: In a personal email, Jewell said: "This post was reviewed, as are all others that mention medicines or disease states. There have been many on the blog, Twitter and Facebook." Upon searching the AZ blog site for other posts that mention CRESTOR, I could not find any post that mentioned the product name AND the disease state (high cholesterol) it is approved to treat. There were, however, a couple of posts that mentioned CRESTOR without its indication. 

Why did AZ do this at this time? It seems to be very opportunistic considering that it coincides with the release of CDC data that shows improvement to cholesterol levels for many Americans. Also, Pfizer just announced it is no longer promoting Lipitor (see "Pfizer Throws In the Lipitor Marketing Towel" and "Lipitor R.I.P. Infographic").

Obviously, now is a good time for AZ to ramp up the promotion of CRESTOR, as it is positioned to take over the number one (or virtually ONLY) statin TOP sales spot (see chart below):

It's also obvious that AZ wants to take some credit for the results reported by the CDC, which are summarized in the following "infographic" (creating infographics is a new obsession of mine):

Some interesting conclusions can be made from the data in this CDC report, which you can find here.

For one thing, women are not doing as well as men in terms of lowering their total cholesterol. This is especially true for women aged 60 and over. Women in that age group have consistently higher percentages of high total cholesterol than men.

The percentage of adults with low HDL cholesterol was higher for men (31.4%) than for women (11.9%).

Although the CDC does study the use of statin drugs by adults and breaks this down by sex and age (see top chart in the infographic), the CDC's analysis that is highlighted in AZ's blog post is based "only on measured cholesterol and does not take into account whether medications are taken."

That's too bad. It would have been interesting to see the correlation between statin use and lowered measured cholesterol.

More important than managing cholesterol levels, however, is whether or not statins actually improve health outcomes such as heart disease. There are results from clinical trials that indicate such a benefit, but how does that correlate with results in the real world?

Just curious.

Crestor Grapples to Compete with Lipitor: #Fail!

Crestor Grapples to Compete with Lipitor: #Fail!

I just got this email from AstraZeneca via Pharmacist eLink, which is a National Community Pharmacists Association site sponsored by the pharmaceutical industry (click on image for an enlarged view):

As readers of this blog know, my doctor once recommended I switch to Crestor from my generic pravastatin, which costs me about $7 per month via mail order (it would cost me $4 if I weren't so lazy and got it at Wall Mart). After my doctor received "speaking fees" and food from Pfizer, she recommended I switch to Lipitor because it was going off patent.

My personal experience is just one example of how Pfizer's "Save Lipitor" strategy is upsetting the statin apple cart these days.

Back to the Crestor email ad I received. First of all, this email is supposedly aimed at pharmacists who signed up to be members of the Pharmacist eLink Web site. Of course, I was able to sign up without proving that I was a pharmacist. I suggest that savvy healthcare consumers would do the same. Consequently, this ad may reach many consumers.

But AstraZeneca is trying to offer pharmacists an alternative to Pfizer's deal with PBMs that encourages pharmacists to provide "generic Lipitor" when fulfilling prescriptions for generic statins such as pravastatin. To grease the wheels of that deal, Pfizer is offering consumers a rebate that in many cases would drive the copay down to $4 per month.

But the Crestor offer doesn't sound too competitive to me: It offers a "Savings" card that promises consumers can get "CRESTOR for just $8 more than the copay of a generic statin." That is, the maximum copay would be $18 ($8 more than the average $10 copay for generics).

What consumer would be impressed by offers that cost more than what they are already used to paying? And $18 is considerably more than the $4 they would pay for generic Lipitor.

One mitigating factor, however, is that the Crestor "Savings" card will cover a 12-month supply, whereas Pfizer's savings plan expires in 6 months.

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After I posted this, I received the following clarification from a Media Relations person at Pfizer: "I read your post today, and I think you may be confusing the Lipitor For You co-pay card with our brand loyalty programs with PBMs and health plans during the 180 exclusivity period that make the branded Lipitor available to patients at a total cost that is lower than the generic alternative. The only inaccuracy was saying the co-pay card was good for 6 months. It is actually good until the end of next year. It did appear you were blurring the lines between the two programs."

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IMHO, the Crestor offer seems likely to fail and will have absolutely no impact on keeping Crestor competitive.

BTW, Pharmacist eLink has a lousy privacy policy and a bogus opt-out mechanism. When I click on the link to unsubscribe, what I get is merely a form to "Update your account settings" (see below), which does NOT have any "unsubscribe" option.

Meanwhile, the Pharmacist eLink privacy policy regarding opting out merely states "You may request not to be contacted by Pharmacist e-Link in connection with any new services, updates, or promotions. Requests not to be contacted by e-Link should be sent to info@pharmacistelink.com."

This is not a very user-friendly opt-out process. I will contact "info@pharmacistelink.com" and notify them of my displeasure -- as if I didn't have more important things to do!