Survey Halted, Drug Makers Seek to Protect Hormone Sales
By: MELODY PETERSEN
NY Times, July 17, 2002
When female patients have asked in recent days
whether they should continue taking Prempro, the hormone replacement
therapy, doctors have told roughly half of them to stop taking the drug or
to switch to an alternative treatment, a survey of doctors has found.
The survey of 338 doctors, conducted last Friday by
ImpactRx, a drug marketing intelligence firm, bodes poorly for sales of
Prempro and for the drug's maker, Wyeth.
The stock price of Wyeth plummeted early last week
when researchers announced that they had stopped a long-term study of
women taking Prempro after finding that patients had a small but increased
risk of breast cancer, heart attacks, strokes and blood clots.
Timothy A. Margraf, the president of ImpactRx, said
yesterday that it was far too early to tell how many women would stop
taking the drug, which earned Wyeth about $900 million in sales last year.
Primary-care physicians surveyed told about 42
percent of the patients who asked them about Prempro last week that they
should remain on the drug. Doctors said they told about 37 percent that
they should stop taking it. Some 11 percent of patients were told to
switch to another therapy.
ImpactRx conducted the survey, Mr. Margraf said, to
see how Wyeth and makers of competing products were reacting to the
Prempro study ≈ known as the Women's Health Initiative.
The survey showed, for example, that sales
representatives from Wyeth who promote Prempro tripled the number of
doctors they visited last week compared with the week before the study
came out.
Some competitors have also jumped at the opportunity
to gain sales as women seek alternative treatments. For example, the
survey found that representatives from Pfizer,
who were promoting FemHRT, a hormonal therapy similar to Prempro, doubled
the number of doctors they visited last week compared with the week
before.
Some of those Pfizer representatives told doctors
about the Prempro study and suggested FemHRT as an alternative, the survey
found. It found a similar increase in physician visits last week by sales
representatives at Pharmacia,
who were promoting a similar hormone treatment called Activella.
At Wyeth, Dr. Victoria Kusiak, vice president for
global medical affairs, said the company was finding that most doctors
were making decisions on whether to continue prescribing Prempro, based on
each patient's circumstances.
The company stressed in letters sent to doctors last
week that the Women's Health Initiative study had found a higher risk of
breast cancer in women who had taken the drug for four years or more and
that it had not questioned the drug's ability to relieve hot flashes,
night sweats and other problems suffered by women entering menopause.
Dr. Kusiak said that the company had asked its sales
force to call on all the significant prescribers of Prempro to let them
know that the study was coming out and to explain its findings. "The
doctors were anxious to hear from our reps," she said.
She said it was too soon to say how many women would
stop Prempro.
A Pharmacia spokeswoman, Caroline Bullock, confirmed
that the company's representatives had increased calls to physicians about
Activella last week.
"Women are going into doctor's offices and
asking to come off Prempro, but they still need alternative
treatments," she said.
The part of the Women's Health Initiative study that
was halted included only Wyeth's Prempro, which contains a mixture of
estrogen and progestin. While the hormonal treatments that compete with
Prempro contain forms of estrogen and progestin chemically different from
Prempro, there is no evidence yet that they are safer than Prempro.
The makers of nonhormonal drugs used to treat
osteoporosis are also trying to take advantage of the Prempro study.
Besides helping to relieve symptoms of menopause, one of Prempro's
approved uses is the prevention of osteoporosis.
For example, sales representatives from Eli Lilly
told doctors they visited last week that the company's drug Evista was a
safe alternative to hormone therapy, according to the ImpactRx survey.
"We're doing a lot of education," said
Lauren Cislak, a Lilly spokeswoman. She said the company wanted to make
sure that patients and doctors knew that Evista did not include estrogen
or progestin, like Prempro and the other hormonal treatments.
Merck
& Company ran a full-page ad in The New York Times on Sunday,
promoting Fosamax, another drug that treats osteoporosis. The ad made it
clear that Fosamax is a nonhormonal treatment.
"We're encouraging women to have a discussion
with their doctor," said Gregory Reaves, a spokesman for Merck.
Mariann Caprino, a spokeswoman for Pfizer, said the
company's discussions with physicians about FemHRT might have increased as
doctors who were curious about the study asked the company's sales
representatives for more information.
"There is tremendous complexity involved in
understanding this study," Ms. Caprino said. She said Pfizer did not
talk about the number of visits its sales representatives were making or
other marketing strategies. Pfizer is in a $60 billion deal to buy
Pharmacia.
Plaintiffs' lawyers have begun filing lawsuits
against Wyeth because of its marketing of Prempro. A suit filed on Monday
by Kenneth B. Moll, a lawyer in Chicago, seeks compensation for thousands
of women around the country who may have been injured by the drug.
A spokeswoman for Wyeth said the company did not
think there were any legal or factual bases for such lawsuits.
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