Unleashing the Power of Nexium

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Lynda Sears

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By Lynda Sears

Unleashing the power of NEXIUM Taking the gastrointestinal market by storm, AstraZeneca follows up its own best in class proton pump inhibitor with a product that’s even better.

ATTENTION PHYSICIANS AstraZeneca’s salesforce is in the field touting Nexium’s ability to eradicate heartburn symptoms, a big patient benefit

Supported by overwhelming clinical success, Nexium’s marketers hope to change the prescribing behavior of physicians in the gastrointestinal community.

Nexium has the potential to upstage Prilosec, AstraZeneca’s blockbuster gastroesophageal reflux disease (GERD) product that for years has been the No. 1 selling pharmaceutical product in the world.

Since its launch this spring, Nexium has created a lot of interest in the gastrointestinal community because of its ability to eradicate heartburn symptoms, a patient benefit that no one was talking about until recently.

“In the development of Nexium, we chose to study very stringent end points and not just look for reduction or improvement in symptoms,” says Lisa Schoenberg, product director with AstraZeneca. “There was simply not a need in the market for another “me too drug.”

AstraZeneca researchers found their new gold mine very close to home. Nexium, developed as an optical isomer, is composed of one of the two molecules within Prilosec. The company is capitalizing on a specific advantageous component found within its older product.

“To bring value to patients, we needed to demonstrate a significant difference versus Prilosec,” says Roger Adsett, senior product manager with AstraZeneca.  “And that’s what we were able to produce. We came in as the fifth proton pump inhibitor, but Nexium is the first to show a clinical differentiation … a totally different story than what the competition offered when they launched.”

Since Prilosec’s launch in 1989, four other proton pump inhibitors have  .  entered the gastrointestinal disorder market — TAPPharmaceuticals’ Prevacid, Janssen Pharmaceutica’s Aciphex, Wyeth Ayerst Lab oratories’ Protonix, and now AstraZeneca’s Nexium — however, none has had the financial success of the original. As the first proton pump inhibitor on the market, Prilosec offered a dramatic benefit profile versus the H2 antagonists traditionally prescribed.  Sales of Prilosec were more than $6 billion in 2000.

AstraZeneca invested heavily in additional clinical studies to maximize Nexium’s indications. “There is clearly room for improvement in this marketplace,” Mr. Adsett says.  “A majority of patients using proton pump inhibitor therapies are not satisfied.” In the United States, unlike competing products, which were launched with one indication, Nexium was launched with four indications: heartburn and other symptoms associated with GERD; the healing and symptom resolution of erosive esophagitis, an inflamma tion of the esophagus that may occur with GERD; the maintenance of esophagitis symptom resolution and healing; and the eradication of Helicobacterpylori infection in patients with duodenal ulcer disease in 10 days when used in combination with certain antibiotics.

Both Nexium and Prilosec block the final step of acid production by inhibiting an enzyme system at the secretory surface of the stomach’s parietal cell. Nexium is currently available in Sweden, the United Kingdom, Germany, and the United States. “We could have done two studies, and received a claim, but to stick to the theme of science, efficacy, and meeting patient needs, we came out with a broader base of indications at launch,” Ms. Schoenberg says. Nexium sales could reach $3.5 billion to $4 billion each year at its peak, including $2.5 billion in U.S. sales, according to ING Barings.

But some analysts have questioned the sales potential of Nexium, wondering to what degree the drug is superior to Prilosec and why doctors would prescribe Nexium instead of a less expensive, generic version of Prilosec. Prilosec’s patent protection has expired in most world markets. “We are truly in a unique situation, in that AstraZeneca innovated the proton pump inhibitor, being the first PPI on the market,” Mr. Adsett says. “Relying on the science and tying that benefit to the patient, we are doing a lot of the same things that we did with Prilosec, as far as stressing the efficacy, stressing the safety, stressing the patient benefit. We are in a unique situation — we are fairly innovative in that we are the first company that can follow up its own best in class PPI with something that is clinically proven to be better.

As for what we do with that, I think it goes back to the basics: provide the science to the physician and provide the benefit to the patient. We think we have a winning combination of both of those to have success with Nexium.” The challenge for AstraZeneca marketers is their case with a scientific perspective and on their salesforce to communicate the scientific message to physicians. Nexium is the first pro ton pump inhibitor to be approved using clinical studies in which the active control was tested against another proton pump inhibitor. The previous four proton pump inhibitors were launched with studies comparing end points against an H2 antagonist or placebo. “We’ve demonstrated that Nexium can do better than Prilosec,” Mr. Adsett says. “And we have the clinical data to back it up.” Another marketing strategy is to play off the  “purple pill” theme established by Prilosec. “Nexium’s campaign is seeking to leverage to convince physicians to switch from Prilosec, or a generic version of the product, to Nexium. Physicians and patients, generally comfortable with Prilosec, simply don’t recognize the potential for something new and better. One of AstraZeneca’s marketing strategies is to increase the level of communication about GERD.

AstraZeneca’s marketers are depending on Nexium’s clinical portfolio to prove One of the biggest obstacles that AstraZeneca’s sales force is expected to encounter with the launch of its new proton pump inhibitor Nexium to physicians is over coming the “Prilosec” factor. Physicians are very comfortable with prescribing Prilosec, AstraZeneca’s first proton pump inhibitor; the challenge for Nexium’s marketers is to communicate the scientific advantages of the new brand.

According to Lisa Schoenberg, product director with AstraZeneca, the company began with district training meetings at regional sites last August. At those meetings, the salesforce went through a simulation process. They spent two days practicing detailing to physicians. Some sessions involved real physicians,others were with sales managers or training specialists. “The sales reps spent their first two days in a closed train ing environment,” Ms.Schoenberg says. “They interacted with counterparts,entered notes on what transpired with physicians, and planned follow up calls.This process really gave them a flavor for detailing to physicians and how,over time, those calls can evolve.

This is a great training module that we put in place. “We focused very heavily on the science,” Ms.Schoenberg says. “Every sales rep who sells Prilosec had to go through the training module for Nexium.We made no assumptions about anyone’s knowledge of the science or the clinical data.

Nexium is a science based product, a science based discussion, and a science based sell.” AstraZeneca’s science is what is expected to differentiate Nexium from the other proton pump inhibitors on the market: Prilosec, Prevacid, Aciphex,and Protonix. “The other proton pump inhibitors that have entered the market subsequent to Prilosec haven’t been able to offer a clinical improvement to the patient,”says Roger Adsett, senior product manager with AstraZeneca. “Physicians have become very comfortable with Prilosec’s efficacy and safety.

To now come and demonstrate a new product that offers advantages,positively differentiated from Prilosec on clinical endpoints, that’s real news to physicians, and they need to come to grips with that and what it means. Nexium has an advantage coming from AstraZeneca because we have a reputation of entering new advances into the gastrointestinal marketplace, but we are dealing with tremendously satisfied customers who are comfortable with Prilosec. It’s a double edged sword, it’s a blessing, but it is also a challenge for us.”

At a recent Nexium launch meeting, Lisa Schoenberg, product director, introduces the core visual aid sales specialists will use to detail the proton pump inhibitor to physicians. Nexium is a science based product, a science based discussion, and a sciencebased sell. success of Prilosec in the marketplace and build off that success,” says Mark Reichman, account supervisor, Grey Healthcare, a New York advertising agency.

“From both an execution and tactical standpoint we’ve tried to appeal to physicians and consumers in terms of what are the unmet needs in the category and how Nexium can fill those unmet needs.”

AstraZeneca is investing considerable resources to make Nexium a winner in a crowded market. “We have invested very heavily in this product; we did far more clinical studies than we needed to do to launch a product,” Ms. Schoenberg says.  “We have close to 3,000 sales people support ing the product. We are fully behind Nexium so that we can achieve everything possible.”

With so many sales reps handling the product, AstraZeneca faces the challenge of ensuring that all of the company’s people are well trained and have confidence in the product.

“We have a lot of new sales people,” Ms. Schoenberg says. “It is a tough job being a sales rep in this field. There is a lot of competition, doctors are very busy … they don’t have a lot of time. Most of our salesforce was in the field about three months before we launched.”

Experience in the field and in the home office is expected to benefit Nexium’s performance. “I have worked with Prilosec since 1993 and there are a number of people on this team who have worked with Prilosec for a very long time,” Ms. Schoenberg says.  “We are not here to say that we have a great marketing plan or marketing strategy because it’s innovative. We feel we have a great marketing plan and strategy because we know this market better than anybody else. There is huge potential for this product.”

AstraZeneca’s marketers are confident that they can make inroads into the proton pump inhibitor market with Nexium.

“We are trying to expand formulary approval within hospitals,” Mr. Adsett says. “We will do scientific programs and make them available to further the science of PPIs and manage gastrointestinal disorders through sponsored programs with gastrointestinal fellows and with the residents in training in the gastrointestinal marketplace. We are really focusing on gaining formulary acceptance based on the science, based on the clinical benefits to the patients.”

AstraZeneca offers state of the art con sumer and professional Websites, electronic newsletters, and the ability for physicians to customize patient education materials over the Internet. The company is receiving instant feedback about the launch of Nexium via a market research campaign conducted with physicians over the Internet.

So far feedback from physicians has been positive. Primary care physicians note that Nexium is big news, offering patients once weekly therapy for H. pylori infection at a cost savings of about 75% because of the reduction in treatment time. Later in 2001, when the company has achieved the right level of physician awareness and comfort with the product, AstraZeneca plans to kick off a consumer advertising campaign.

“We have a database of Prilosec patients and we are able to do some direct marketing and direct communication,” Ms. Schoenberg says.  “It is permission marketing.”

When taking into consideration how big the market is, as well as the products in the marketplace that have little clinical differentiation from Prilosec, our goals for Nexium are pretty high,” says Paul Jansson, senior product manager, AstraZeneca.


Nexium (esomeprazole magnesium) Launch date: March 2001 Marketer:AstraZeneca 2000 sales: N/A 3 Aciphex (rabeprazole sodium) Launch date: August 1999 Marketer: Janssen Pharmaceutica 2000 sales: $1.7 billion 1 Prilosec (omeprazole) Launch date: 1989 Marketer: AstraZeneca 2000 sales: $6.3 billion 2 Prevacid (lansoprazole) Launch date: April 1998 Marketer:TAP Pharmaceuticals 2000 sales: $2.8 billion 4 Protonix (pantoprazole sodium) Launch date:February 2000 Marketer: WyethAyerst 2000 sales: N/A

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