Brilinta

Ha Ha. Kind of reminds me of the AZ spin early in the game. If you forget a QD dose you do not have the drug on board for a day. If you forget one dose BID you are still covered half a day.

 

Actually, it depends on what 'covered' you mean. You could miss three or four doses of Brilinta and still have the inhibition of Plavix. Look it up.

 

... and there you have it. Spin city.

 

Just remember Plato study showed no benefit in Stemi patients p=0.07 and no added benefit in diabetic patients versus Plavix. Bid is a real issue for many. 30-40% of post pci patients do not fill their first script of Plavix. They are on so many medications do you think bid helps? I have sold Plavix for nine years and have a lot of cath lab experience. It's over for me but good luck to you all. You have at rough road ahead of you. And for you new reps calling on interventionalists talk to them like a normal human being, not marketing ! They hate the way you guys do the "what do these bleeding numbers mean to your practice"? Really stop it's not helping you !

 

Where are YOU going? Plato .07 was driven by the increased incidence of stroke. Pull that out and Plato prevented MI and death better than Plavix in STEMI patients. That is the whole point anyway of giving these drugs. Just stay away from individuals at higher risk of stroke would be my thoughts.

 

I am an interventional rep. I know what you mean about how to talk to a CI. Any "crafting" of a B.S. sentence is going to send them right out the door. I actually think that is why this drug is doing so poorly. Half of the management for this division or more, do not even know who the platelet thought leaders are in the country. Astounding!

 

In our hospital, we use Effient a good bit, and have for a while; about 1/2 of our stent cases. We have not had any problems with bleeding. Several of our patients that have received Brilinta (although not too many overall yet) have come back with Dyspnea. I think this could be a problem. Also the reps that call on us are very pushy and dont seem to answer the doctor's questions in a straigt forward way, which doesn't help. They bad mouth other products, which we don't like either. We will give it time, but so far, unimpressive.

 

You sorry ass reps can't sell shit! This drug should have already REPLACED Plavix! If I could, I would put every damn one of you on a PIP, give you 30 days to turn it around, or your ass would be replaced! There are plenty of excellent reps that have been laid off that would love to get a chance with this drug!! You're all useless!

 

Effient had $340 million in sales for 2011. Projected @ $440 million 2012. It has 1 indication and more than 50% of that market. All of my accounts have Effient on protocols for STEMI and NSTEMI. I seem to be getting a bit of the UA and medical management patients. Know I'd get more but my clinicians are frustrated with all the call backs due to managed care access! I fear we are screwed once Plavix goes generic especially if Effient stays tier 2.

 

Yeah, it will be rough because what you said is a hinge in being able to move this product. When the head to heads come out, little by little, Brilinta will be moved over and Effient will only be used in pts that have Dyspnea as the third choice. STEMI data might provide more protocol changes.

 

.07 IS STILL NOT STATISTICALLY SIGNIFICANT IN MY BOOK. NO BENEFIT IN STEMI PATIENTS WITH BRILINTA VS. PLAVIX. DO YOU UNDERSTAND? NO BENEFIT! WHY WOULD YOU USE A BID, ONLY LOW DOSE ASPIRIN, DSYPNEA, VENTICULAR PAUSES, NO MANGED CARE COVERAGE, GENERIC ON THE WAY WHEN THERE IS NO BENEFIT? DUH? ALSO NO BENEFIT IN DIABETIC OR DES STENTS? PATIENTS AT HIGHER RISK OF STROKE WHAT ARE YOU TALKING ABOUT? IT IS OBVIOUS YOU DO NOT EVEN KNOW YOUR DRUG OR THE MARKETPLACE! I WISH I WAS SELLING IN YOUR TERRITORY.

 

Troll. . . where is that? You looking again at JUST the U.S. data which is basically too small to make any comparison. I hope this is not what they are teaching AZ reps in training.
http://www.theheart.org/article/1022873.do
As you can quickly see: Benefit in the STEMI primary endpoint! .02
All cause mortality: Benefit in STEMI! .04

 

Really? DE stenting? Why is there a 1A to use the drug then from the ACC?

http://www.brilintatouchpoints.com/acs-guidelines/

 

Why I love to read this thread... You Mr. AZ name calling person. You don't even know your own studies. The STEMI substudy did have a .07 P-value. If you argue this point, it only makes you look stupid. The diabetes substudy, showed no benefit as well. You cannot state a case that has no merit. My favorite, if your take out the stroke patients, then we have benefit. Why not just argue that your product is really a QD dosed product, but it was given a bad rap by the FDA. Another favorite of course is that even if a patient is non-compliant, the patient is still covered. Do you even know how compliance was defined in your study, hmm, ???? It was pitiful and occurred in a controlled study.

 

Effient troll. . . you must be worried to be trolling these boards. From 2012 thought leaders:
They conclude: “We estimate that use of ticagrelor instead of clopidogrel for 1 year in 1000 patients with acute coronary syndromes and who are planned to undergo an invasive strategy at the start of drug treatment would lead to 11 fewer deaths, 13 fewer myocardial infarctions, and six fewer cases of stent thrombosis without an increase in the rates of major bleeding or transfusion.”

Don't worry, I am sure you can spin the diabetic who does not go to the cathlab as a good Effient pt or for those who do indeed get dyspnea and it does not go away.

 

Really? I am looking at PLATO right now and it says .005 for MI. Like I said, you cannot just pull out the U.S. results - that makes YOU look stupid. The trial was not designed nor powered to do something like that. You have to take the global results, whether you're happy about that or not. The explanation after looking at many population variables was due to the ASA dose - since those results were duplicated across the globe. It is in the label. Troll.
http://www.nejm.org/doi/full/10.1056/NEJMoa0904327#t=article
The primary end point occurred significantly less often in the ticagrelor group than in the clopidogrel group (in 9.8% of patients vs. 11.7% at 12 months; hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001

 

So you use European results in discussions with your Physicians?

 

I have always referred to the STEMI substudy in which they look at STEMI patients only numb nuts. In this specific and correct me If I'm wrong prespecified STEMI substudy, there was a P-Value of .07 = NOT SIGNIFICANT. Any other data you look at from this substudy is then irrelevant. I stand by your data.

 

n PLATO STEMI, 8430 patients with STEMI scheduled to receive primary PCI were randomized to either 180 mg of ticagrelor during PCI, followed by 90 mg twice daily for six to 12 months (n=4201) or 300 mg of clopidogrel with a provision for an additional 300 mg of clopidogrel during PCI, followed by 75 mg daily for six to 12 months (n=4229). All patients also received daily aspirin therapy. Of the patients, 75% received a stent, the majority of which were bare-metal stents.

The ticagrelor group suffered fewer cardiovascular events, with the primary end point of MI, stroke, or vascular death being significantly reduced, by 15%, with ticagrelor compared with clopidogrel (hazard ratio 0.85; p=0.02), without any increase in major bleeding complications, whichever definition of bleeding was used. The number needed to treat (NNT) with ticagrelor to avoid one primary end point was 59 in this STEMI subset, said Steg. He noted that the results were very consistent regardless of the loading dose of clopidogrel that patients received (300 mg or 600 mg), noting that a third of participants did receive the higher loading dose of clopidogrel.

Definite stent thrombosis was also significantly lower among the STEMI patients taking ticagrelor compared with those receiving clopidogrel, as was MI.

And there was an 18% reduction in all-cause mortality among those STEMI patients taking ticagrelor vs clopidogrel (p=0.04), although there was no difference between the two arms in terms of cardiovascular death in the STEMI subset, in contrast to the PLATO trial as a whole, which saw significant reductions in both all-cause and cardiovascular mortality with ticagrelor compared with clopidogrel.

The p value was .02 for STEMI for the primary endpoint. Case and point. You HAVE to use the European data to talk about the trial to U.S. doctors. I get the cardiovascular death endpoint, but there are other endpoints that were significantly better as pointed out above by Dr. Jennings and Dr. Steg. Not me. These are the leading experts in this field.

 

Well, they are already using European data to decide how to treat their patients. . . been doing it for years. Do you realize how many read all the European guidelines and prefer them to the U.S. ones or come up with their own based on a combination of many factors? There are few trials, if any, that are U.S. only. If you get 30 percent U.S., that is a lot. This is how it is in the REAL world. Do your docs like Acuity? Cased closed.