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Biotech / Medical : VVUS: VIVUS INC. (NASDAQ)
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To: Little Gorilla who wrote (19034)2/23/1999 7:05:00 PM
From: VLAD  Read Replies (1) of 23519
 
Yes,

I have been told by MUSE patients that do experience discomfort that often the discomfort goes away after the 3rd or 4th use and that the greatest discomfort is felt on the first one or two dosings.

The only problem with that is that many men will quit if they experience any significant discomfort after only the first use.

Another solution to this problem which Vivus sales reps did not promote until it was too late is the use of the Actis band. Using the band prevents the initial alprostidal from seeping into the groin/testicles where discomfort may be felt. By using the band, one prevents any extrapenile venous flow of the alprostidal and allows it to do its job where it is supposed to in the erectile tissues of the penis.

As Edderd explained long ago, he has the patient remove the band after 1/2 erection is achieved. By then most of the alprostidal has been absorbed through the urethra and into the erectile tissue and will not be available to move out of the penis once the band is removed.

Just another example of how MUSE is a technique oriented product and needs more doctor and client education than popping a pill. Also why I think MUSE sales continue to do well in England along side with Viaga. The Astra reps took their time to properly detail the product to the urologists who in term took the time to properly instruct the client. Now that Astra has also begun detailing MUSE to the general practicioners, we probably can expect to see MUSE product sales to continue to increase in England.

Another mistake that the Astra sales team didn't fall into which was a problem with the 1997 Vivus sales force product detailing to urologists in the US is that they properly instructed them to begin titration at the 500ucgm dose. This way if 500ucgms didn't work there was only one higher dose to try whereas initially in the US the urologists were starting at the 125 or 250ucgm dose. A patient requiring 1000ucgms to achieve a decent erection was much more likely to quit the titration if he failed on 125 and then 250ucgms or 250 and then 500ucgms. By starting on 500 the chances of a successful outcome is much greater than starting on 125 or 250. Most men don't have the patience to try going through 3 or 4 titrations before figuring out that it takes the highest dose to be successful. This is why during MUSE's first year Vivus lost a lot of patients who failed when starting on the lower doses and never kept progressing onto subsequent titrations.
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