Asmanex... what happened?

[Anonymous]

I don't get it. It is a very easy to use device, it is QD from onset, it shows superior efficacy that Flovent, Pulmicort etc. It's mometasone. Why don't we have higher M.S? We have sold this for over 1 year and still docs prefer to write Qvar? Are you kidding me? Where did we go wrong?

[Anonymous]

I don't get it. It is a very easy to use device, it is QD from onset, it shows superior efficacy that Flovent, Pulmicort etc. It's mometasone. Why don't we have higher M.S? We have sold this for over 1 year and still docs prefer to write Qvar? Are you kidding me? Where did we go wrong?

Before you get a bunch of replies telling you that "you should be fired if you can't sell Asmanex", or "Asmanex sucks", or any other waste-of-time responses, let me give you a serious response.

This was my favorite drug to sell for a while, MS was growing, physicians were interested. But it has really become stagnant. In my territory, I still have MS higher that QVAR, Pulmicort, Azmacort, but Advair and Flovent are killing me. I have tried until I was blue in the face to stress the importance of using a single agent for mild-moderate, but physicians just don't care. Advair is easy for them. That's the problem with the healthcare system today, physicians are seeing patients, not treating them. I'm only asking for 2-3 out of 10 scripts, which is not much, considering Asmanex is probably appropriate for 6-7 out of 10. The GSK reps, whatever their tactics have been (credible or shady), have done a good job maintaining share, even though I hate to say it. The only thing I can tell you is this, you just have to get angry and create a sense of urgency with your physicians. No more Corren, no more D'Urzo, no more QD talk, no more ease of use talk. It's time for "What reasons could you possibly have for not including Asmanex in your treatment of Asthma patients?" They can't write less than 0, so what's it going to hurt?

[Anonymous]

I have an answer to the question for the doc from above "You are 6 years too late and too damn expensive"!!!!!!!!!!!!!

[Anonymous]

I have an answer to the question for the doc from above "You are 6 years too late and too damn expensive"!!!!!!!!!!!!!

Do you know anything about Asmanex? If you're claiming that it is too expensive, either you live in an area where the Managed Care status is poor, or you're an idiot. 2nd tier on 80% of plans in my territory and only Flovent is less expensive for cash patients. Oh, and QVAR, but nobody writes that here.

[Anonymous]

The quick answer is that docs write out of habit and what's easy for them. Advair is too much but it gets patients in and out so the doc can see more patients and flovent is out of habit. You should be putting Flovent down soon though.

[Frustrated]

QVAR rocks in my area! No matter what I do the docs are telling me about ease of use of Advair and sometimes they have switched Flovent to QVAR too. I asked the question above about "why wouldn't they try Asmanex? I was told by one of my leading dDocs.that it doesn't bring anything new to the table. Advair is easy and frankly any single agent can be dosed once per day too, once you have achieved control of you patient. My docs can read too and the information onAsmanex even says that vbettrer results may be achieved with BID dosing...Plus..Asmanex does a great job of treating 1/2 of the lung and misssed a whole buch other. Really. So I just make sure that when my manager is with me that I take him to the docs who like iut sa little so that he doesn't get put under fire. Ahhhahgaghghag...

[Anonymous]

You must be in California, Qvar sucks everywhere else

[Anonymous]

Honestly, why such a shitty volume and market share, given the # of reps out promoting this product? Advair gets butt-raped by the FDA and the media and you guys can't get more than you've got? It's sorry to think what piss-ant Symbicort will do to you when it gets out... Is SP where good reps go to die, or is it something else?

[Anonymous]

Made more on Foradil than I ever did on Asmanex!!!! Maybe LABA's are a better choice than ICS?

[Anonymous]

So is this why SP gave PSS a part time contract to sell it to pcp's?

[Anonymous]

Incentive comp or just poor marketing? Can't be the sales force quality...

[Anonymous]

So is this why SP gave PSS a part time contract to sell it to pcp's?

OH? I thought PDI was selling Asmanex and PSS was selling Clarinex?

Wait, are they going to pit them against us to see who is the better of the bunch? YOu know they say PDI outsold us last period/target for target. Now we have to up our calls and be like them.

[Anonymous]

We still sell this shit???

[Anonymous]

Heard that Pulmicort is coming out with a new device... should we be worried?

[Anonymous]

Who is the idiot in HO that in charge of Respiratory? No vision or direction = lack of backbone to help drive the product.


I don't get it. It is a very easy to use device, it is QD from onset, it shows superior efficacy that Flovent, Pulmicort etc. It's mometasone. Why don't we have higher M.S? We have sold this for over 1 year and still docs prefer to write Qvar? Are you kidding me? Where did we go wrong?

[Anonymous]

Who is the idiot in HO that in charge of Respiratory? No vision or direction = lack of backbone to help drive the product.

Corky on the McJobs program.

[Anonymous]

PSS is pulling together a flextime (24 hrs./3 days/wk) salesforce nationwide to sell asthmanex, clarinex and nasonex to pcp's, so SP reps can sell to allergists. F2F interviews going on now with hiring date in next couple of weeks. Rumor is SP plans to terminate the PDI contract in a couple of months.

[Anonymous]

PSS is pulling together a flextime (24 hrs./3 days/wk) salesforce nationwide to sell asthmanex, clarinex and nasonex to pcp's, so SP reps can sell to allergists. F2F interviews going on now with hiring date in next couple of weeks. Rumor is SP plans to terminate the PDI contract in a couple of months.

If that's the case, why do we need so many SP reps?

[Anonymous]

PSS is pulling together a flextime (24 hrs./3 days/wk) salesforce nationwide to sell asthmanex, clarinex and nasonex to pcp's, so SP reps can sell to allergists. F2F interviews going on now with hiring date in next couple of weeks. Rumor is SP plans to terminate the PDI contract in a couple of months.

How credible is the rumor? Perhaps both teams, PDI and PSS, will be selling respiratory products relieving SP Reps to promote other products. Will PSS have specilist as PDI lost all allergists, pulminologists, and higher ranking physicians?

[Anonymous]

So what's the deal?

Why are we having such a tough time?

Is QVAR safer than Asmenex?

[Anonymous]

I don't get it. It is a very easy to use device, it is QD from onset, it shows superior efficacy that Flovent, Pulmicort etc. It's mometasone. Why don't we have higher M.S? We have sold this for over 1 year and still docs prefer to write Qvar? Are you kidding me? Where did we go wrong?

I wouldn't give you 5 cents for the difference between the ICS's you listed.

You went wrong by becoming a me-too med.

[Anonymous]

I wouldn't give you 5 cents for the difference between the ICS's you listed.

You went wrong by becoming a me-too med.

Me-too med in a crappy device. Don't believe the hype--patients hate it.

[Exasberated]

Fact is that the Allergists are tired of getting lied to by the SP reps. This product is dead...

[Anonymous]

What exactly are we lying about?

[Anonymous]

I'm a long-time asthma patient on inhaled corticosteroids and albeturol as needed. I've been on flovent for years. Everything has been fine until the past two months when Kaiser put me on Asmanex. First of all, the whole twisthaler thing simply adds extra steps that are annoying. Patients get used to the flovent-type single-depression device and it is quick and easy. You don't need a frickin' meter reader; you can tell when your inhaler is low just by holding it. Floating it in a cup of water is just as quick. I had no breathing problems with Flovent. With asmanex, my asthma came back with a vengeance and for the first time in about 8 years, I had to go on a nebulizer. I called my doctor and asked to be put back on Flovent.

[Anonymous]

I'm a long-time asthma patient on inhaled corticosteroids and albeturol as needed. I've been on flovent for years. Everything has been fine until the past two months when Kaiser put me on Asmanex. First of all, the whole twisthaler thing simply adds extra steps that are annoying. Patients get used to the flovent-type single-depression device and it is quick and easy. You don't need a frickin' meter reader; you can tell when your inhaler is low just by holding it. Floating it in a cup of water is just as quick. I had no breathing problems with Flovent. With asmanex, my asthma came back with a vengeance and for the first time in about 8 years, I had to go on a nebulizer. I called my doctor and asked to be put back on Flovent.

What he's really saying; read between the lines:

I'm a long-time GSK rep. I've been selling flovent and advair for years. Everything has been fine until the past two months when Kaiser put Asmonex on formulary. First of all, the whole twisthaler thing simply confuses me, how can I sell against another, safer DPI? Patients got used to the flovent-type single-depression device and it was quick and easy, then we came out with Advair. But even though you don't need a frickin' meter reader we put one on Ventolin anyways. I spread disinformation by saying you can tell when your inhaler is low just by holding it or floating it in a cup of water. I had no problems lying with Flovent. With asmanex, I tell docs asthma comes back with a vengeance because for the first time in about 8 years I have had to sell against a better product. I called my doctors, posing as a patient, and asked to be put back on Flovent as a last ditch effort.

[Anonymous]

This is not that complicated a question. The marketing plan sucked from the start AND then the "go after Advair" decision made it worse. Some of the people who helped set the plan in place from the sales side have been promoted. That goes to show you how ignorant senior leadership is and their BS focus. They couldn't recognize talent if it hit them in the face. All they look for is "kiss ass".
Anytime you get the Senior sales VP to put out a "how to sell" guidance, you know you are screwed. The only bag that guy has carried for 30 years is between his legs and that is not even a certain fact.

[Anonymous]

Product marketing and layouts (even accounting for regional variations and anticipated managed-care incentive holdbacks) really will not matter much in the long run. By the end of 2007, asmanex will not even be on this discussion board. Sales reps cannot be expected to know this for the simple reason that most forget to think like a lazy consumer-patient. The very thing that makes the device novel--the twisthaler--will prove to be the downfall of asmanex. It really does not matter that it might be more efficacious. Asthma patients are notoriously bad at managing their condition. They do not take it as seriously as patients with other conditions. You cannot give this population base, now involving increasing numbers of children, a more complicated delivery device--even if it is not b.i.d. Remember your stoner friends in college? Remember their love affair with their bongs? One puff gets you high. No meter reader. No twisthaler. Easy.

My advice? Get off this bandwagon.

[Anonymous]

I honestly have no idea what all of you idiots are talking about!!! Do you have any idea what the company's original goals for Asmanex were??? Do you know where we arrived in relation to those goals???

Well I will tell you.... it is very simple:

The company expected Asmanex to generate $60 million in 2006.
We ended up generating $90 million in 2006.

So what in the bloody hell is everyone yapping about on this site? No!! Asmanex will never have the market share that Advair has, but it has already surpassed Pulmicort, Azmacort, and QVAR on a national scale. So quit whining you bunch of rotten piss ants! And by the way, if you think that we are doing poorly with Asmanex because nobody hit their goals or made any money, then welcome to the new Schering-Plough....You will always be made to believe that you COULD be doing more or that you are not driving sales enough, regardless of how much money the company is actually pulling in!!! This is the life of the new SP, so get over it!!!

[Anonymous]

$90 million? How much of that ended up in your pockets? Thought so. You'd be better off selling colon cleansers door-to-door.

btw, notice i chose not to use any foul language in my post? enough of this potty mouth talk. just tell us what we you need to say w/o the nasty language. us older reps would appreciate that. thx!

[Anonymous]

You are all self-flagellating whiners. Asmanex? Building relationships with physicians? Worrying about ever-increasing quotas that you will never meet? I live in the Bay Area, California. I sell dope. Medical marijuana is legal in California. Doctors write scripts for this on the drop of a dime. Every little dope head can get a medical marijuana card and get all the legal cannabis they want. What fuck with big pharma when you can just grow the shit in your backyard and hand deliver big fat stinky buds directly to your physician groups. I am making a goddam killing out here. So stop your stupid piss ant whining and start selling weed.

Peace out brother.

[Anonymous]

What is this A B C marketing going on now. You guys are unbelievable

[Anonymous]

Hey - this is not a complicated device to use. Pulmicort is complicated to use CORRECTLY and you never really know how many doses are left - even if you CAN find the dopey red line.. You can still suck on an empty inhaler..

Great news for Proventil though, hunh?

[Anonymous]

What is this A B C marketing going on now. You guys are unbelievable

We are unbelievable...unbelievable is sort of an infectious disease in the asthma market...it has infected you ass clowns at GSK as well.

Realistically, you should be ashamed that you have convinced doctors that guidelines when treating asthma don't matter. You know you're not 1st line therapy after albuterol but you sell it as that.

All we are trying to is remind docs that 75% of their asthma patients should not be on Advair.

[Anonymous]

Talk to your docs. Seldom does a patient come into their office FOR ASTHMA unless the are using their albuterol daily (most are using 3 to 4 times daily). This is a moderate persistant asthmatic patient by guideline definition. That is an Advair patient, period. Look the data, go to Chocrane review look at the studies. No brainer. There are many mild persistant asthmatics out there, but they are not coming into the doctors office. Asmanex is a great ICS, but no better than Flovent. Asmanex and Flovent are definitely superior to Pulmicort. Asthma is horribly under diagnosed in America. To say 75% of asthmatics should not be on Advair is false to put it VERY politely.

[Anonymous]

Below is a excerpt from one of the lead researchers for Advair:

GLAXOSMITHKLINE PRIZE 2000
Antagonism of long-acting β2-adrenoceptor agonism
Brian J. Lipworth
Asthma and Allergy Research Group, Department of Clinical Pharmacology & Therapeutics, Ninewells Hospital and Medical School, University of
Dundee, Dundee DD1 9SY UK

Subsensitivity of salbutamol protection against bronchoconstrictor stimuli occurs in patients receiving concomitant long-acting β2-adrenoceptor agonists, which may be due to β2-adrenoceptor down-regulation or prolonged receptor occupancy. Prospective large scale long-term studies are required to further define the clinical relevance of β2-adrenoceptor polymorphisms, to look at clinical control outcomes as well as propensity for subsensitivity. It would therefore make more sense to first of all optimize the dose of anti-inflammatory therapy with inhaled corticosteroid and to then consider adding a long-acting β2-adrenoceptor agonist for patients who are poorly controlled.

[Anonymous]

18 May 2004 Annals of Internal Medicine Volume 140 • Number 10

Despite the lack of data, present guidelines recommend intermittent use of
short-acting
2-agonists as rescue treatment for exacerbations and regular use of long-acting
2-agonists as secondline treatment to be added to inhaled corticosteroids (1, 2,34). It has generally been thought that long-acting
2-agonists do not carry the same risk for tolerance as seen with the short-acting agents (35). The results of this metaanalysis show that significant tolerance develops with both classes of
2-agonists.

Conflicts of interest in promoting widespread
2-agonist use may have arisen from financial gains through pharmaceutical company funding. The electronic search for this analysis revealed 98 randomized, placebo-controlled trials
of
2-agonist use in patients with asthma (4, 5, 12–32,35–109). A post hoc evaluation showed that 58 of these trials reported pharmaceutical company funding or sponsorship from a company that produced a
2-agonist; 73%
of these trials concluded that
2-agonists were beneficial. However, of the 40 trials that did not report any pharmaceutical company funding, only 10% concluded that
2-agonists were beneficial.

The development of tolerance seen in this analysiscould explain the association found between
2-agonist use and an increased risk for fatal and near-fatal asthma attacks(6, 7, 121–123). It could also explain the pattern of escalating
2-agonist use or
2-agonist “addiction” that has been described, as well as reports of rebound bronchoconstriction seen after sudden withdrawal of
2-agonists (33).

[Anonymous]

After those two responses to my "ask the Doc.s" post, I could respond for days. I could site countless journals with volume numbers and page numbers ect. And my case would be made. And you could site Salpeter and her utter garbage which was published in Annals of Internal Medicine etc. where she makes so many rediculous statements such as asthma deaths have increased over the last decade. I really do not have the time to go back and forth on of all things an SP thread. Journals these days are out to sell journals. I subscribe to Hal Nelsons school of thought. If you don't know who he is, you ought to find out.

I will leave with this. Asmanex lost in my territory the day SP rep.s talked our Allergists into taking a substancial number of their patients OFF Advair and putting them ON Asmanex. They were so happy for about a month, but then patients started calling two, three, or even more a day. Patients complaining that they were crashing insisting on going back to Advair immediately. Then came the FP and IM doctors. The were so pissed off that they wrote letters asking why in the hell the allergists were switching their patients off Advair, only to have them come back uncontrolled. This Allergy group lost a lot of business and a lot of face in my community. I heard and watched the nurses curse as they took another call. SP reps lost face, respect and trust. Bummer

You see, clinically Advair kicks ass and doesn't kill people. Doctors have seen this. 70 million plus scripts. Even the most brainwashed SP rep must see that by now. It works A LOT better than Flovent which I sold for two years and Asmanex. All the bullshit theory of tolerance and deaths really pertains to LABAs and SABAs monotherapy. A persistant asthmatic should never be treated with a SABA or LABA montherapy. I could go on and on, but I have a life. We'll see how this year shakes out.

[Anonymous]

Sorry to hear that in your territory. In my territory, the #1, most respected and reknowned Allergist has been amazed with his patients' responses to Asmanex. In his clinic he sees between 15-25% improvement in FEV1 within 1-2 weeks. I promise you this is not BS. Specialists in my territory are sold on Asmanex, and when treating with monotherapy, Asmanex is their ICS of choice. Now at the same time, most of them think it is hogwash that Asmanex is in the same market basket as Advair, especially the 500, because they see a distinct difference in treating with monotherapy vs. combo. Our FPs have not jumped on board, because a lot of them are no-sees, so it hurts us trying to influence them to prescribe a new product, where it does not really hurt the GSK reps, because all they have to do is hope the FPs keep doing the same thing they have always done, which is pretty much all FPs know how to do. The unfortunate fact that we have to face is that, no matter what disease state, FPs are now simply "seeing" patients as opposed to "treating" patients. It's rather sad, really.

[Anonymous]

Let's face it ASMANEX sucks big time cock and so do all the SP female reps - even some of the guys do too. ASMANEX is considered a me-too drug because it is no different than PULMICORT. Stop the bullshit already and get on with your lives. GSK wins all the time not because they have a better drug(s) but because they are smart enough to buy the docs.
There is no nobility in trying to be ethical -GSK is the proof of the pudding - if you want big time market share and lots of moolah - buy your docs - but in respiratory, GSK has cornered the market - so you aint gettin' none. I would say SP stands for SHIT PRODUCTS - not Schering-Plough.

[Anonymous]

To the GSK Asspert who could "comment for days". Two things; 1. Your own company awarded Dr. Lipworth their prize and he's conclusion wasn't and if, may, might statement. He distinctly said "Subsensitivity of salbutamol protection against bronchoconstrictor stimuli occurs in patients receiving concomitant long-acting β2-adrenoceptor agonists." 2. I'll bet every study you could quote comes from an article with the tag line: funded by a grant from GSK. You must have had a real hard time slamming Salpeter AND the Annals of Internal Medicine AND the editors who include their comments. I think I'll get my copy back out, go to Kinkos and paper the town with it and the FDA's comments regarding Advair and death.

[Anonymous]

News flash for all of those who keeping putting Lipworth up on a pedestal. Dr. Lipworth was also one of the authors of a paper evaluating the safety of inhaled Mometasone. In the paper the authors go on to say that even though Mometasone is touted to be the "safest" molecule, the reason they report less than 1% bioavailability is because they are not taking into account the active metabolite. Their data "refutes the assertion that Mometasone Furoate has negligible systemic bioavailability and a lower potential for systemic adverse events compared with other inhaled corticosteroids." They continue to state that "clinicians therefore need to be aware that MF has the potential for producing similar adrenal suppression to that of Fluticasone propionate."

The only study that Schering has out that compares the product to anything besides placebo is the study against beclomethasone. First of all, what a fucking joke. I would like to see you use that against a real doctor. The patients on beclomethasone had a lower baseline for cortisol and were being dosed twice a day compared to once a day.

For you koolaid drinking idiots...
Asmanex is NOT any more efficacious than any other product out there. Schering is a marketing machine and together with the fact that they have been using way too many reps to market it produces the success that has been seen. A TON of money has been laid out in order to gain support and our own doctors have been joking about it. I have heard physicians say that I am on the payroll but I haven't had to actually speak ever...nice.

You morons out there that think otherwise need to get a fucking clue!

[Anonymous]

To the GSK Asspert who could "comment for days". Two things; 1. Your own company awarded Dr. Lipworth their prize and he's conclusion wasn't and if, may, might statement. He distinctly said "Subsensitivity of salbutamol protection against bronchoconstrictor stimuli occurs in patients receiving concomitant long-acting β2-adrenoceptor agonists." 2. I'll bet every study you could quote comes from an article with the tag line: funded by a grant from GSK. You must have had a real hard time slamming Salpeter AND the Annals of Internal Medicine AND the editors who include their comments. I think I'll get my copy back out, go to Kinkos and paper the town with it and the FDA's comments regarding Advair and death.

You are an idiot too! Who do you think funds the bullshit studies that schering has put out regarding asmanex? Get your head out of your ass! There are good points out there leading to the conclusion that LABAs are not needed an an everyday basis, but I dare you to run around papering your specialist's offices with your crappy FDA articles. I would love to be there when they slam the door in your dumb ass face!!!!! People like you are the ones who screw it up for everyone else.

[Anonymous]

You are an idiot too! Who do you think funds the bullshit studies that schering has put out regarding asmanex? Get your head out of your ass! There are good points out there leading to the conclusion that LABAs are not needed an an everyday basis, but I dare you to run around papering your specialist's offices with your crappy FDA articles. I would love to be there when they slam the door in your dumb ass face!!!!! People like you are the ones who screw it up for everyone else.

If you had ever had an actual conversation with a doctor (instead of a signature at the sample closet while you say "Try Asmonex!" as the doctor walks away) you would know that most of them are not aware of the many, many, many articles which detract from Advair and long term therapy with LABAs. Half of your job is to educate physicians on protocol and appropriate use, if you can't do that because you lack the knowledge, or skill, then you should look for other employment.

In the meantime get YOUR head out of YOUR ass, visit the Medical Libraries (hint: they are located in the Hospitals) or visit the Internet, read some relevant information, that hasn't already been provided to you by SP, regarding your own drugs and the competition's. Then you might try to engage the doctors in actual conversations where you can third party reference that relevant information(that means refer to something you've read or seen). People like you are the ones who make the rest of us look like uninformed automatons (somebody who resembles a machine by obeying instructions automatically) for big pharma.

[Anonymous]

Dr. Lipworth is a so far up Mercks ass his tonge is touching their tonsils. Talk about on the payroll. Are you kidding me. He was hired, bought, paid for, and paraded around by Merck to sell Singulair.

Also, Primary Care Respiratory Journal (2006) 15, 271-277, Long acting Beta-Agonists in Adult Asthma: Evidence these drugs are safe by Hal Nelson was not sponsored by GSK. Read it if you want. Hal speaks for many drug companies and is the Head of Nation Jewish Allergy Department.

[Anonymous]

Alright, it is not Nation Jewish, it is National Jewish. My bad

PS. If you are going to look at safety, you HAVE to separate LABA's monotherapy vs. in fixed dose combination with ICS's. Current evidence based medicine studies indicate the combo therapy actually reduces exacerbations, hospital visits, withdrawls, albuterol use, not to mention all measures of pulmonary function and is in fact more safe than ics or laba montherapy. Also, Try Cocherane review. It is an online searchable complete medical library. I use it all the time and it is awesome. Don't go to a hospital's library. This is 2007, not 1987.

[Anonymous]

I like to use journals that my physicians actually subscribe to, recognize, want to read, and try to find the time to read like the Journal of Allergy and Clinical Immunology, the American Journal of Respiratory and Critical Care Medicine, Thorax, and Annals of Internal Medicine. These aren't journals that have to rely soley on their advertisers for income, in fact advertisers beg for space, advertising copy has to be approved by the editorial board before accepted, and they don't send out free copies to every office address to pump up their distribution numbers. I don't call on Primary Care physicians so my docs aren't likely to read an article Dr. Nelson (Hal to you) has had to dumb down for the general practice audience and I prefer to read an entire article rather than reviews and summaries written by some unknown person.

Now, even though you've shown a distain for Dr. Salpeter's article, I'm going to quote it one more time because in evidence based medicine you look at the trial outcomes; she looked at the evidence and found this information to be significant, it is not her opinion, it is a finding of the analysis:

"Despite the protective effect seen with corticosteroids, the subgroup analysis in this study showed that the combination of
2-agonist and inhaled corticosteroids still resulted in significant tolerance to the effects of
2-agonists."

I imagine that really grinds your GSK ass and I'm sure you had to scramble to discredit Dr. Salpeter (which probably caused a number of physicians to question your credibiity) but I also imagine that GSK still spends a good chunk of their advertising dollars in the Annals.

[Anonymous]

Salpeter is a known "expert trial withness" for trail lawers across the planet. I challenge you to sit down and use evidence base medicine principles to journal club that paper. She said she looked at all papers regarding the issue. We did a very simple seach and found 11 she left out Guess what?? Every papers result did not support her stance. Imagine that. She was contacted several times at did not comment. Trust me that paper is baised to the point of aburdity by ommitting half the pertanent data that did match the outcome she wanted, it is false. Also, Dr. really appreciate a rep. that can pull bias and objectively show it out of a paper. I have done it with SP studies and GSK studies. Once you learn how to use a EBM Studyguide it you can discredit more than half you my own companys papers as well as yours. Believe me, it was an opportunity to shine.

[Anonymous]

I just read my own reply after putting my kids to bed. I have chide myself before you do. Hukd on foniks workd for me. I had my 12 week old in my lap and my 4 year old wanting to play hot wheels when I wrote it. Anyway, I hope you got my point.

[Anonymous]

I again read my own reply. It was totally full of shit and I must admit I'm a drunk and stupid GSK rep. Forgive me for vomitting GSK crap on your boar once again. Please kkep trying to inform your doctors on the proper protical, I promise I'll only walk in to their offices with donuts and say "Advair".

[Anonymous]

Hmmm... flat to down Nationally. Even a blind squirrel finds some nuts now and then. What's up with the SP salesforce? Are you even mentioning this product?

[Anonymous]

Salpeter is a known "expert trial withness" for trail lawers across the planet. I challenge you to sit down and use evidence base medicine principles to journal club that paper. She said she looked at all papers regarding the issue. We did a very simple seach and found 11 she left out Guess what?? Every papers result did not support her stance. Imagine that. She was contacted several times at did not comment. Trust me that paper is baised to the point of aburdity by ommitting half the pertanent data that did match the outcome she wanted, it is false. Also, Dr. really appreciate a rep. that can pull bias and objectively show it out of a paper. I have done it with SP studies and GSK studies. Once you learn how to use a EBM Studyguide it you can discredit more than half you my own companys papers as well as yours. Believe me, it was an opportunity to shine.

Salpeter pooled 22 studies, you found 11 they met your needs (aka supported long term use of LABAs), therefore Slapeter's article is crap. Now you want me to believe you show doctors the bias and objectivity of the studies you pull out of your bag. I'll bet you never once say "Doctor, let me show you this study, funded entirely by GSK. Notice that many of the researchers involved are also employed by GSK. And look! Miraciously Advair is superior!" What your EBM Studyguide teaches you is to how to hide the data that doesn't support your interests.

[Anonymous]

I give up. You're a moron. The funny thing is, we (GSK reps and SP reps) are friends and get along in my territory. We realize that Asmanex, Flovent and Advair are all great medicines. GSK and SP INVENTED Albuterol and Beclomethasone for crying out loud.

The problem with Asmanex is it was not first to market. (see Nasonex) When I started at GSK in 2000, we had a tab for Asmanex in our training binder and our company spent a decent amount of time reviewing it as competition. Fortunately for us, it didn't launch until September 2005.

But here is the kicker, as we do what ever the hell it is we are doing, SP is desparately trying to get a Foradil / Mometasone combo to market. It will be a great drug. You will be pushed to promote it first. (Because it will be a better drug and more expensive with a longer patent life) You will probably not even promote Asmanex anymore. You will watch Asmanex grow because you will talk about it anyway and not get paid a dime.

I am not a hater or a cool aid drinker. Have a nice life. I mean it.

[Anonymous]

My problem with Salpeter is she stated she pooled all available data on this subject that met her criteria. You can't do ameta-analysis that is credible and leave out all the studies that MATCH YOUR CRITERIA but don't support you preconceptions. This is called LYING OR AT BEST MISLEADING. No, it is lying. Very simple. Do you get it, at all??

[Anonymous]

My problem with Salpeter is she stated she pooled all available data on this subject that met her criteria. You can't do ameta-analysis that is credible and leave out all the studies that MATCH YOUR CRITERIA but don't support you preconceptions. This is called LYING OR AT BEST MISLEADING. No, it is lying. Very simple. Do you get it, at all??

Salpeter pooled 22 studies, you found 11 they met your needs (aka supported long term use of LABAs), therefore Slapeter's article is crap. Now you want me to believe you show doctors the bias and objectivity of the studies you pull out of your bag. I'll bet you never once say "Doctor, let me show you this study, funded entirely by GSK. Notice that many of the researchers involved are also employed by GSK. And look! Miraciously Advair is superior!" What your EBM Studyguide teaches you is to how to hide the data that doesn't support your interests.

[Anonymous]

Who sponsors Asmanex studies? The NIH? The holyer than thou Asmanex study fairy? I try to be fair and ojective but you are blind (I went out of my way to pick a nice word). Show me the bias in an Advair Asthma study.

[Anonymous]

Who sponsors Asmanex studies? The NIH? The holyer than thou Asmanex study fairy? I try to be fair and ojective but you are blind (I went out of my way to pick a nice word). Show me the bias in an Advair Asthma study.

First, it is holier than thou. Second, if you don't see any biases in your Advair studies the you are an fucking idiot (I went out of my way to pick the right words). Show me when an Advair study showed that after being brought under control it was safe to back down to standard of care.

I've gone out of MY way to be nice. You've been coming over here (to the SP board) to try and demoralize a team who is simply trying to convince and educate physicians to return, or in the case of the draft NIH guidelines, to proper protocol. That protocol is to step therapy up from Albuterol to ICS and Albuterol, to a larger dose of ICS and Albuterol and then to add on therapy. That add on therapy might include any number of agents but as you folks at GSK would have us believe it means one thing; why not just start them on Advair to begin with. You started out marketing that combination to pulmonologists and allergist saying "This isn't a product for the masses, Doctor, it's for specialists". Now you can find Advair samples in every physician office across the country, including OBGyn and Podiatrists. I guess your tune changes with the times; market share and sales are king! Damn the torpedoes! Sell that drug!

[Anonymous]

The guidelines are not step therapy you idiot. Our indication from the FDA clearly states you can START, yes, START with Advair, even if the patient is NOT on any controller medication, with Advair. The guidelines state correctly that preferred therapy is ICS plus LABA for a moderate persistent asthmatic. That would be a patient with an FEV1 of less than 80%, waking up more than one time a week, or daily symptoms. And Yes we have studies looking at stepping down patients down from Advair to an ICS alone or staying on advair and advair is superior. There is no study that supports doubling the dose of an ICS is better than ADVAIR. There is also NO study that says Advair, not LABA ALONE, is not safe. Combination therapy studies, whether it be advair or symbacort, consistently show better syptom and exacerbation controll than ICS alone. These are facts.

[Anonymous]

By the way, I am not trying to demoralize anyone or any team. Please understand, I spent a year dealing with SP rep.s throwing away my samples, lying daily about Advair, and trashing my company. Merck was the same way. You have a great ICs, and there is a billion dollars of Flovent sitting there (well actually growing) and your management decides to go after advair? Hundreds of patients got screwed and ended up in ERs and doctors offices because doctors took patients off a great, SAFE, drug. A lot of these patients had already failed on ICS alone. I started selling flovent in 1999. Trust me, Advair is an awesome drug.

[Anonymous]

By the way, I am not trying to demoralize anyone or any team. Please understand, I spent a year dealing with SP rep.s throwing away my samples, lying daily about Advair, and trashing my company. Merck was the same way. You have a great ICs, and there is a billion dollars of Flovent sitting there (well actually growing) and your management decides to go after advair? Hundreds of patients got screwed and ended up in ERs and doctors offices because doctors took patients off a great, SAFE, drug. A lot of these patients had already failed on ICS alone. I started selling flovent in 1999. Trust me, Advair is an awesome drug.

According to you, why bother with an ICS at all, jump right to Advair.

[Anonymous]

DATA FROM A LARGE PLACEBO-CONTROLLED SAFETY STUDY THAT WAS
STOPPED EARLY SUGGEST THAT SALMETEROL, A COMPONENT OF ADVAIR
DISKUS, MAY BE ASSOCIATED WITH RARE SERIOUS ASTHMA EPISODES OR
ASTHMA-RELATED DEATHS.

[Anonymous]

For the patient that needs it, Advair is the best drug for them. Problem is, that most patients that get Advair don't need it. Primary care physicians, for the most part, only see their asthmatics when they're exacerbating, so they throw the kitchen sink at them to get them under control, and then never see them again until they lose control again. It's a pathetic, vicious cycle that repeats ad nauseum, and I've spent the last three years trying to figure out a way to help my docs get their asthmatics to come back to the office for a follow up visit.

Want to sell more Asmanex? Figure that one out. I'll sell more Singulair, you sell more Asmanex, and the only patients that get Advair are the ones that truly need it.

[Anonymous]

For the patient that needs it, Advair is the best drug for them. Problem is, that most patients that get Advair don't need it. Primary care physicians, for the most part, only see their asthmatics when they're exacerbating, so they throw the kitchen sink at them to get them under control, and then never see them again until they lose control again. It's a pathetic, vicious cycle that repeats ad nauseum, and I've spent the last three years trying to figure out a way to help my docs get their asthmatics to come back to the office for a follow up visit.

Want to sell more Asmanex? Figure that one out. I'll sell more Singulair, you sell more Asmanex, and the only patients that get Advair are the ones that truly need it.

The decline continues...who's promoting this crap these days? Is that why PDI was canned? You'd think a company with as strong of a Resp portfolio could do a bit more. Perhaps Merck should buy you out?

[Anonymous]

Going after Advair with Asmanex is like wiping your arse before you take a dump. It makes no sense and it's a waste of time.

[Anonymous]

You must be in California, Qvar sucks everywhere else


This is a BS post. I sold QVAR and my territory was 4 times the size of big pharma going against 10-12 reps from Glaxo and then all the Schering people on top of that. I grew my Qvar market share from 2% to 14% in the Southeast. How did I do it? By running my territory smart and selling on science, not marketing.

[Anonymous]

You tell em how it is SULLY!

[Anonymous]

I'm one of you, watching my Asmanex share continue to grow. But I do feel guilty, especially for those of you who think we have the best drug on the market. Quit blowing yourselves. I hear Doc after Doc tell me AdScare works, Flovent for uncontrolled, and QVAR if they're not. Managed market world folks, launch is over. You aren't selling a better drug, our own studies say beclomethasone is safe. Drug with the best studies on the market has 100 Reps behind it. If you can't keep QVAR at bay, you aren't doing your job.

[Anonymous]

I wouldn't give you 5 cents for the difference between the ICS's you listed.

You went wrong by becoming a me-too med.

This is the right answer. So you can show one re-print that shows that QD Asmanex beat QD Pulmicort. That is only 1 study and most docs truly believe a steroid is a steroid is a steroid. So docs resort to their usual prescribing habits and frankly are probably a bit annoyed that they have to banter with enthusiastic SP reps selling a "new drug" that is very little different than Vanceril circa 1978.

[Anonymous]

This is the right answer. So you can show one re-print that shows that QD Asmanex beat QD Pulmicort. That is only 1 study and most docs truly believe a steroid is a steroid is a steroid. So docs resort to their usual prescribing habits and frankly are probably a bit annoyed that they have to banter with enthusiastic SP reps selling a "new drug" that is very little different than Vanceril circa 1978.

Sounds like 1/2 the drugs being peddled right now in this industry...."Dr, its the same, ONLY BETTER!!!!!!!!...." What a bunch of crap. There are too many BS me too drugs, too many follow-ups, ie Clarinex, Nexium (wow, just slap nex on any old drug and you have a new revenue stream, hmmm, maybe Nasonex and Asmanex suffer from this BS syndrome as well). I have worked in this industry for ten years and have made a good living but honestly I am amazed at some of the shit that management (industry in general) has tried to wrap up in a new coat and stick a bow on and present as the greatest thing since sliced bread.

I know that my job is to sell what you stick in my bag, but please, don't insult my or the drs i sell to's intelligence. I don't blame hospitals, insurance companies and IHNs for doing DURs and opting for generics and older drugs that balance cost and efficacy. Hell, I have to do the same thing when making choices about the items I buy for my family everyday including food, clothing, entertainment, etc.

If this industry wants to preach about the value of the products it is delivering, then it needs to deliver innovative new drugs that justify the cost. Drugs like morphine were developed thousands of years ago and companies are still trying to charge top dollar for them.

[Anonymous]

Explain to me exactly how being the only ICS currently on the market approved for QD dosing from initiation is "me too". I'm not drinking the Kool-Aid, trust me, but there are advantages to Asmanex. If a "steroid is a steroid is a steroid", then wouldn't it be more desirable and advantageous for a patient to be prescribed the steroid that is a once-daily medication, with the easiest delivery system on the market? As opposed to a BID med requiring 10 steps and 4 minutes to dose each time (Azmacort), a non-sampled BID medication requiring hand-breath coordination (Flovent), or another BID med that has been shown to be inferior in efficacy to Asmanex (Pulmicort). According to your logic of them all being the same, then Asmanex should be the ICS of choice based solely on unique features beneficial to the patient. Just my opinion.

[Anonymous]

Explain to me exactly how being the only ICS currently on the market approved for QD dosing from initiation is "me too". I'm not drinking the Kool-Aid, trust me, but there are advantages to Asmanex. If a "steroid is a steroid is a steroid", then wouldn't it be more desirable and advantageous for a patient to be prescribed the steroid that is a once-daily medication, with the easiest delivery system on the market? As opposed to a BID med requiring 10 steps and 4 minutes to dose each time (Azmacort), a non-sampled BID medication requiring hand-breath coordination (Flovent), or another BID med that has been shown to be inferior in efficacy to Asmanex (Pulmicort). According to your logic of them all being the same, then Asmanex should be the ICS of choice based solely on unique features beneficial to the patient. Just my opinion.

Indications are only so important. Just because Asmanex has a QD indication doesn't mean that other steroids don't work QD or aren't used QD. QD Flovent, Qam Advair are very frequently prescribed by MDs. With experienced docs they know that any steroid can work QD. Because the market historically had been BID the older steroids have never even been studies QD and so many of these drugs like Flovent and QVAR are old, soon to be generic, and not worth the companies time to do studies to prove QD indication.

[Anonymous]

You must be in California, Qvar sucks everywhere else



If you lived in California why would you need any of this man made drugs? Marijuana is the true medicine for asthma.

[Anonymous]

Let's try the Advair kills campaign again. It got the worthless idiots that provided the advice for the Chicago launch promoted. That set the stage for failure. A horrible marketing team and poor management focused on the numbers. It would never work for a me too product.

[Anonymous]

Let's try the Advair kills campaign again. It got the worthless idiots that provided the advice for the Chicago launch promoted. That set the stage for failure. A horrible marketing team and poor management focused on the numbers. It would never work for a me too product.

I have to say this thread makes me laugh so hard my stomach hurts. I was a respiratory rep and left in fall 2006 to go to a real specialty sales force...selling asmanex sucked and management was CLUELESS! I HOPE ALL YOU SP DRONES GET CANNED IN THE ACQUISITION!