Concerning Zyprexa, I think you'll be interested in this article:
April 14, 1998 12:59 AM
DOW JONES ONLINE NEWS
ANTIPSYCHOSIS DRUG
FROM ELI LILLY SCORES
LARGE MARKETING GAINS
By Thomas M. Burton, Staff Reporter of The Wall
Street Journal
In a surging marketing war with vast implications for
American society and public health, Eli Lilly & Co.'s
Zyprexa is headed toward becoming the world's first
billion-dollar-a-year antipsychotic drug.
Lilly will soon disclose that Zyprexa achieved sales in the
first quarter of about $280 million. And analysts are
estimating that 1998 sales of Zyprexa will land between
$1.1 billion and $1.4 billion.
But market leader Risperdal, from Johnson & Johnson,
isn't losing sales and could reach the $1 billion mark first,
though it concedes Zyprexa recently took over the No.
1 spot. Analysts expect its 1998 sales to be between
$980 million and $1.1 billion.
The new drugs are helping tens of thousands patients,
chiefly with schizophrenia, to lead more normal lives.
Schizophrenia, a chronic disorder that involves
hallucinations and a profound withdrawal from society,
has long been one of the world's most devastating
diseases, leading millions to be institutionalized or to lead
desperate lives on the streets.
"These new drugs truly are a breakthrough," says Laurie
Flynn, executive director of the National Alliance for the
Mentally Ill. "They mean we should finally be able to
keep people out of the hospital, and it means that the
long-term disability of schizophrenia can come to an
end."
None of the new drugs, including Zyprexa, is an outright
cure for schizophrenia or psychosis. But in one study,
about 20% of Zyprexa patients were back at work a
year after beginning treatment, compared with about
10% for haloperidol, a widely used older antipsychotic.
Many patients who had dropped off older therapies
because of painful side effects are beginning to stay with
treatment on the newer drugs. "The market is expanding
for antipsychotic medicines," says independent analyst
Hemant K. Shah. In particular, he adds, "Zyprexa has
simply defied gravity."
The intensity of the marketing wars will soon be
ratcheted up a notch. Zeneca Group PLC has just
entered the U.S. market with its drug Seroquel, and
Pfizer Inc., renowned for marketing prowess, soon will
enter the fray with Zeldox. And the growth of Risperdal,
generically called risperidone, hasn't slowed much since
Johnson & Johnson introduced it in 1994.
After gaining U.S. marketing approval in October 1996,
Zyprexa, known generically as olanzapine, had 1997
sales of $730 million.
Its growth has much to do with Lilly's success in
convincing government officials in all 50 states to place
Zyprexa on their "formularies," or approved lists of
drugs. Achieving this was in doubt because Lilly charges
a premium for the drug, particularly when compared
with older generic drugs like haloperidol. Lilly's
contention is that it works better than Risperdal and
older drugs, and many mental-health professionals
agree.
"I think Zyprexa is a wonderful drug for psychotic
patients," says John Zajecka, associate professor of
psychiatry at Rush Medical College in Chicago. Dr.
Zajecka says Zyprexa also has advantages over
Risperdal in treatment of another condition: the "manic"
stage of bipolar disorder, also known as
manic-depression.
Zyprexa has one major drawback: a tendency to cause
weight gain. But with severe illnesses such as psychosis
and schizophrenia, the most important test of a drug
simply is whether patients are willing to stay on it. Lots
of patients cannot tolerate the side effects of older drugs
like haloperidol (Haldol) and chlorpromazine
(Thorazine). These drugs cause "extrapyramidal
symptoms," which are jerky, uncontrollable movements
of the arms and legs similar to Parkinson's disease
symptoms.
"The real world is finding that Zyprexa has fewer
extrapyramidal side effects than Risperdal," says
Harvard Medical School associate clinical professor of
psychiatry William M. Glazer. Johnson & Johnson says
Risperdal often achieves a therapeutic dose without
creating such side effects. And Dr. Glazer agrees that
"you're still going to see doctors who only prescribe"
Risperdal.
Schizophrenia and psychosis are probably best known
for causing hallucinations and voices that "speak" to
patients. These are called the "positive" symptoms of
schizophrenia. The disease also has so-called negative
symptoms like lethargy, inability to socialize and lack of
spontaneity.
"Zyprexa seems to have a robust effectiveness on the
negative symptoms," Dr. Glazer says.
Another big factor in Zyprexa's success is that, since the
Parkinson's-like symptoms generally don't occur even at
higher doses, patients are able to take more of it to keep
symptoms under control. Five-milligram doses of
Zyprexa, taken twice a day, cost $324.99 for a month's
supply at a typical Chicago-area drugstore. A
comparable price for Risperdal was slightly more,
$352.09 for a month's supply of two milligram tablets
taken three times daily.
Also favoring Zyprexa is its lower incidence of sexual
side effects. Psychiatrists say the older drugs, and to
some extent Risperdal, create greater amounts than does
Zyprexa of the hormone prolactin, associated with
nursing in women. The hormone also can lead to sexual
dysfunctions in both women and men. Zyprexa "is the
first option to avoid sexual side effects," says Dr. Glazer.
Another older drug does have many of Zyprexa's
advantages: Novartis AG's Clozaril, or generically
clozapine. But in some patients it causes a
sometimes-fatal blood disease called agranulocytosis
and it also can lead to seizures. The Food and Drug
Administration requires Clozaril patients to get regular
blood tests, a hurdle to widespread use. Because of the
dangers, the great research focus in the treatment of
schizophrenia has been to find a drug that is as effective
as Clozaril without the dangers.
Clozaril still had substantial sales of $500 million yearly
world-wide in 1997, Mr. Shah says. He predicts that
amount will fall to $450 million or less this year because
Clozaril now faces generic competition.
By no means do all psychiatrists prefer Zyprexa. "I don't
see much difference in efficacy between the two drugs,"
says Henry Nasrallah, professor of psychiatry at the
Ohio State University. He says that in his own research
there is little difference between Zyprexa and Risperdal,
too, in the incidence of extrapyramidal side effects. Dr.
Nasrallah says Zyprexa seems to have "a little bit
quicker" effect on depression-like symptoms associated
with schizophrenia. But he says that Risperdal, by
contrast, "works faster on the hallucinations" of
schizophrenia and is somewhat cheaper for a
comparable effect.
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