dmab sales

Anonymous · Feb 6, 2011 at 3:41 PM

Anonymous said: ↑

Few points in response to this poster, and a question for Endodoc:

First, remember when George Morrow stated that Nursing Homes were full of patients with hip fractures....whatever the reason. Maybe why that is one of the reasons GM is now a Consultant. Nursing Homes are not full of patients like this to ever make a difference in DMab sales, and these places would NEVER pay for DMAB for a once every 6 month injection, and MD's would make no money since the injections would need to be given there. We don't even have reps that know anything about Nursing Homes and the reimbursement challenges, so how can we address this market anyway.

Second, for the Endodoc, I thought your post was terrific. Unfortunately, Amgen has become a very unhappy place to work for many. As an MD, I am sure you would not like being micromanaged to death, being tracked about where you are every half hour of the day (by some of the more insecure Managers), and so on, but that is our fate many days. The fact that the DMab marketing strategy was loaded with incorrect assertions and overblown sales targets by the Ivory Tower folks that live and work out of Thousand Oaks doesn't help and now they want to blame the sales force for their ineptitude for not having the uptake be quicker. Amgen has great science, but not great Business Minds. In this day and age, you need the latter every bit as much as the former.

Lastly, for the Endodoc, Cafepharma has become a sort of gathering place for the unhappy folks to feel safe to vent their frustrations. When a company is doing well, you will not see many posts on their Message Board. When you see alot of activity, you can be well assured that the great majority of posts/responses will be slanted towards the negative.

I, for one, thought your post was one of the most informative I have seen in a long time. However, just be aware that most Amgenites like myself are fed up being treated like children despite many, many reps in the field being more experienced than their Managers are, than our Home Office is, and are looking at alternatives to get away from Amgen, and in some cases outside this dying industry....

Toodle Ooh
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Unreal, I never said that the patients in nursing homes would be enough to create a blockbuster for Prolia, my point was that, if it is indeed all about the patient, then ANY patient in a nursing home for an avoidable reason is a shame. If a patient has been put on alendrenate for 5 years with a stable BMD most docs view that as a success; however a 65 year old with a 2.9 is MUCH worse than a 55 year old with a 2.9. This drug can help many patients like this, and the data supports my assertions...clearly.

To the endo doc I say this, you ping pong patients back and forth between bisphosphonates, citing Reclast and its advantages. I think you and your colleagues cannot have it both ways. You whine that you don't want to talk to sales reps and their "me too" drugs that lack innovation. Now Amgen has brought you something truly innovative and you run back to that which you are comfortable. You have patients, more than you are willing to acknowledge, who need this drug. In time you will see that Amgen is on the right side of this argument.

Good luck to you.

Anonymous · Feb 6, 2011 at 6:07 PM

Anonymous said: ↑

It's really interesting to me. So much of what is posted on message boards in general, and this one is no exception, is self-serving bulls**t. Yet when I take the time to try to and provide an educated response to the question as to why DMAB sales are not taking off as fast as some people would like, aspersions are cast. And to the poster who replied about Prolia having better fracture data than IV Boniva, you missed my point - I couldn't agree more (IV Boniva doesn't have any fracture data - which is why the only parenteral BP I use is Reclast).

Hey, take it or leave it. I am indeed a bone endocrinologist, and found this site during a google search on Reclast when I was preparing a CME talk on osteoporosis at a major medical center. Reading some of the posts by sales reps (some of whom may even be the reps I have been meeting with in my office for the past 20+ years) was pretty interesting, as it provided a look into the attitudes of the sales reps for their own company and management, which was an eye-opener for me. So I then checked out the links for the companies of other osteo drugs, such as Amgen, Merck, Lilly, Sanofi, Roche & GSK.

I agree, it's unusual for an MD KOL to take the time to post on a largely sales rep message board. However, I believe strongly in education, whether it's to my patients, residents and endo fellows, or drug reps. Your colleague posted a question about why DMAB sales were what they are, and I though (perhaps incorrectly) that s/he and perhaps other thoughtful sales reps might appreciate some input from a true expert, who actually prescribes drugs for osteoporosis.

BTW, the views I shared are those of a top osteoporosis expert, and not meant to represent the views of the great mass of prescribing physician's, most of whom don't actually know very much about osteoporosis (e.g., they think it's defined by T-score
< -2.5). The overwhelming majority of prescribers (like >95%) don't know the P3 data for any of the drugs they prescribe, and get most of their drug-specific info from the reps. For example, I just saw a patient who was switched from weekly Fosamax to monthly Actonel because "it is more effective". Right.....

I would expect that once Prolia has better reimbursement, lots of primary care docs and rheums/endos will be incentivized to prescribe Prolia instead of Reclast, as they can buy the drug and administer it in their office, making a profit on both the drug and the procedure twice per year, rather than referring the patient to an infusion center for Reclast once per year (making no profit). But as someone who read the Prolia FDA backgrounder as soon as it was available, and intimately knows the clinical & preclinical data from all the BPs, Forteo, Evista and Miacalcin, I prescribe based on actual data. Which is why I don't ever prescribe Miacalcin (lack of robust anti-fracture efficacy), and why I'm initially cautious about using Prolia (no efficacy concerns, but some safety concerns).

Those who prefer to assume that I'm a fraud are free to ignore the information I provided.

endodoc
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I call BS on this poster. Sounds like one of the many industry docs who couldn't cut it seeing actual patients and now is a "medical director". If indeed a practicing physician, he/she is a piss poor one and a shill to be hanging out on CP. Worst case this quack is trying to spew garbage in an effort to manipulate stock prices. Would you want your mother to be treated by him/her? Do you think the hospitals he/she has privileges would want this type of physician on staff? If you really have the courage if your convictions doc, post your name. Oh, I see. You'll hide behind mommy's skirts just like you did when the big bad future drug rep was pummeling your nose on the playground.

Anonymous · Feb 6, 2011 at 9:04 PM

Current Amgen HSM....to the DOC-this is the typical drivel you will find on this site. To the poster, you certainly seem a little hostile towards an innocent, yet intelligent, post (whether the doc is right or wrong, or an MD or not). If you think what is posted on Cafepharma will drive the stock market then I can see why we are not selling much DMab and why many of us want to leave this place. The quality of personnel and people are not what it used to be when I initially joined, and I largely think it is BAD management that is turning good, talented people into boxcheckers and CYA experts.

Anonymous said: ↑

I call BS on this poster. Sounds like one of the many industry docs who couldn't cut it seeing actual patients and now is a "medical director". If indeed a practicing physician, he/she is a piss poor one and a shill to be hanging out on CP. Worst case this quack is trying to spew garbage in an effort to manipulate stock prices. Would you want your mother to be treated by him/her? Do you think the hospitals he/she has privileges would want this type of physician on staff? If you really have the courage if your convictions doc, post your name. Oh, I see. You'll hide behind mommy's skirts just like you did when the big bad future drug rep was pummeling your nose on the playground.
Click to expand...

Anonymous · Feb 7, 2011 at 2:51 AM

Endo doc,

Everything you printed was very well thought out except, what was brought out by a poster right after your First post,

It states: Patients DON'T comply with their alendrenate. We know that.

So when patients don't take their Gold Standard drug and we know that HAPPENS all the time, proven study, then where is all your Gold standard theory go?? If they don't take it you can scrap everything you wrote..

Anonymous · Feb 7, 2011 at 3:58 PM

Anonymous said: ↑

Current Amgen HSM....to the DOC-this is the typical drivel you will find on this site. To the poster, you certainly seem a little hostile towards an innocent, yet intelligent, post (whether the doc is right or wrong, or an MD or not). If you think what is posted on Cafepharma will drive the stock market then I can see why we are not selling much DMab and why many of us want to leave this place. The quality of personnel and people are not what it used to be when I initially joined, and I largely think it is BAD management that is turning good, talented people into boxcheckers and CYA experts.
Click to expand...

HSM- Wannabe doc but too afraid of sales to carry a nut. Regardless, what in hell is a doc doing trolling CP? I did not say CP would drive stock price but I've met enough shills who are more than willing to spew to analysts.

Anonymous · Feb 7, 2011 at 6:13 PM

Well let"s see what happens with operation "next injection" If they miss then we will see?

Endo Doc - Many of the big institutions are adding it to formulary - Besides Renal there are plenty of patients that are allergic/can't tollerate a BP. Secondly, Many will NOT get the next Reclast dose because of the reactions they experienced.

We have reversability - drug leaves system - your job to get them on the next drug if they don't get their second injection?

Just sayin......

Anonymous · Feb 7, 2011 at 10:23 PM

What does it matter if a Big Institution puts it on formulary...they are still going to be ridiculous limitations on it since Institutions are able to enforce various sorts or control measures much like 3rd Party Payors (Commercial, Medicaid/Medicare, Private Insurance, HMO's....). What is the market in an Institutional setting where non-compliance is not much of an issue since HCP's are always rounding anyway.

That being said, please share who is putting it on formulary, and please go one step further and explain to me how adding it to these formularies is going to contribute to Prolia being a Blockbuster.

Yeah, Me.

Anonymous · Feb 8, 2011 at 9:27 PM

Anonymous said: ↑

If you are truly interested in why Prolia sales are somewhat low, from the perspective of an MD who specializes in osteoporosis -
I think it is a good drug for oncology (e.g., H of M, MBD, etc., and patients with tumors with a prediliction for bone, such as myeloma, prostate and breast cancer). However, currently, for osteoporosis, I'm reserving it for patients who are not appropriate candidates for Reclast, for the following reasons:
1. While the fracture efficacy data are terrific, they are no better than the data for Reclast, but there are several areas of potential concern:
a. 60 mg q 6 months appears to reduce the rate of bone turnover somewhat more than is optimal. Alendronate 10 mg/day or 70 mg/month, ibandronate 150 mg/month, and zoledronic acid 4-5 mg per year (or every 2 years) all reduce the rate of bone turnover by 50-70%, which reduces BT into the pre-menopausal normal range. Which is pretty comparable to the BT effect of full dose ERT. The effect of DMAB 60 mg q 6 months on BT is sgnificantly greater than these agents. While normalizing BT appears to result in improved bone strength, it is at least possible that reducing BT to a greater extent may not be optimal.
b. In this regard, as a bone expert, it is somewhat concerning that about 35% of the patients in the FREEDOM bone biopsy cohort did not demonstrate any TCN label. Not no double label - NO label at all. This finding, which is c/w NO ongoing bone turnover/bone formation, has not been seen in any of the histomorphometry programs with Fosamax, Actonel, Boniva or Reclast.
c. Both ONJ and atypical femur fractures appear to be due, at least in part, to over-suppression of bone turnover. The incidence of ONJ in the DMAB oncology program controlled by Zometa was comparable to the incidence with Zometa (numericaly greater, but NS difference). There are no data from extensive controlled trials (N about 60,000 p-y) that bisphosphonates at osteoporosis doses increase the risk of atypical fractures, although it is possible that they might increase in the risk in a small number of susceptible patients. However, and I speak as a KOL (and I suspect most of my colleagues would agree), if BPs do effect the risk of atypical fractures, I would expect Prolia to be at least as risky, because it reduces BT to a significantly greater extent than oral or IV bisphosphonates.
d. As mentioned by some of your more knowledgable sales rep colleagues, the rebound increase in osteoclastic bone resorption seen after stopping Prolia is of some concern. If patients who d/c Prolia are not placed on a BP, I would definitely predict the possibility of an increased fracture rate, especially in patients with more severe osteoporosis, due to enhanced trabecular perforation. The rebound increase in BT is actually quite impressive, as is the rapid loss of the BMD gains following discontinuation.

So I'm using Prolia in a couple of patients with pretty severe renal failure, and a couple of the rare patients who appear to be idiosyncratically sensitive to BPs (e.g., severe muscle & joint pains with oral BPs). But in the great majority of patients with moderately severe to severe osteoporosis, the 1st line is alendronate. If there are GI tolerability issues, or compliance issues, or evidence of poor absorption, I change to Reclast. Think about it from the perspective of the prescribing physician - with no efficacy advantage over Reclast, but with some additional safety concerns, and a smaller safety database (which will improve with time, of course), why would I go with Prolia right away?

This is not the fault of the sales reps, it's based on the controlled trial data. As more safety data rolls out, there's definitely the possibility that I may prescribe it for more patients. But no one should have predicted that this would be a blockbuster (for osteoporosis - I'm not talking about oncology here) right out of the blocks. Which I know doesn't help you with your sales targets, which are probably unrealistic in the current safety-focused environment.

endodoc
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I think this sounds a lot like Dr Mone Zaidi from New York. If so, I know you are reputable, but I would never use you as a speaker with this viewpoint. BTW: How do you explain Reclast barely achieving non-inferiority in their study vs. Alendronate? In fact, based on the study Alendronate appears to increase BMD much better than Reclast at 12 months. Interesting that the non-inferiority study done with Prolia and Alendronate showed Prolia to be the better drug in terms of BMD gains. If patients fails to improve on oral bisph. what evidence do have that would suggest that Reclast is better? None, right? Prolia has 2 studies STAND and DECIDE that give good reasons to use Prolia instead of or as follow on therapy to bisphsphonates.

Anonymous · Feb 19, 2011 at 8:24 AM

Zometa rep here...how's the uptake in bone mets patients going? You guys were big talkers 6 months ago. Let me tell you what I'm hearing. A supportive care drug twice the price of the standard of care with modest benefit. CC < 30 patients make sence which is less than 10% of my patient base. Oh and I'm sure you've heard MD Anderson will not use dmab unless a patient fails Zometa 1st. What?...your marketing team didn't tell you guys that? Believe me ours did. Have fun when you come up $100 million short of goal this year. Wall Street is so understanding.

Anonymous · Feb 22, 2011 at 8:19 AM

Anonymous said: ↑

Zometa rep here...how's the uptake in bone mets patients going? You guys were big talkers 6 months ago. Let me tell you what I'm hearing. A supportive care drug twice the price of the standard of care with modest benefit. CC < 30 patients make sence which is less than 10% of my patient base. Oh and I'm sure you've heard MD Anderson will not use dmab unless a patient fails Zometa 1st. What?...your marketing team didn't tell you guys that? Believe me ours did. Have fun when you come up $100 million short of goal this year. Wall Street is so understanding.
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I've started hearing this every day from my accounts. The problem is their right. The price of this drug in this environment will be our undoing.

Anonymous · Feb 23, 2011 at 8:33 PM

Anonymous said: ↑

I've started hearing this every day from my accounts. The problem is their right. The price of this drug in this environment will be our undoing.
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No zometa rep would waste time here. Probably a disgruntled sales rep who didn't make DM

Anonymous · Feb 25, 2011 at 9:02 AM

Xgeva is being hurt by

1) Predatory pricing
2) Amgen's know it all attitude - we surely don't
3) Recent publications in JCO that show only limited benefit in selected patient
populations and question the value proposition (see point 1)

Anonymous · Mar 7, 2011 at 9:08 PM

Anonymous said: ↑

Xgeva is being hurt by

1) Predatory pricing
2) Amgen's know it all attitude - we surely don't
3) Recent publications in JCO that show only limited benefit in selected patient
populations and question the value proposition (see point 1)
Click to expand...

We sell more Nplate than dmab. Pathetic

Anonymous · Mar 8, 2011 at 8:43 AM

Anonymous said: ↑

Maybe the incorrect assertions and overblown sales targets you refer to were an effort to prepare for an acquisition that never happened. DNA & Wyeth were purchased but apparently AMGN did not represent a good value, now we are just drifting aimlessly like a submarine with a broken rudder!
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Lol. King Kevin S. was a submarine capt.! Very appropos analogy.... no if he can just hurry up and hit the underground canyon wall like the movie "Abyss"....

Anonymous · Mar 16, 2011 at 10:21 PM

Why PMO therapy is dead

Physicians have treatment of osteoporosis well below other more acute disease states.

Managed care

no longer a shared voice pushing the disease state, at one time as many as 6 reps calling on one physician from various companies

A generic that works

PMO drug therapy should be an OTC market

Specialty for the very hard and difficult to treat

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