 Physician & Payer Forum --
April 2008
 In This Issue...
On May 21, 2007, the New England Journal of Medicine
published a meta-analysis showing that GlaxoSmithKline’s Avandia (rosiglitazone)
is associated with elevated risk of cardiovascular mortality (Nissen SE, 2007).
Later that year, the FDA issued a black box warning for Avandia and Takeda’s
Actos (pioglitazone). Both agents are members of the peroxisome
proliferator-activated receptor gamma (PPAR-gamma) agonist class (also called
thiazolidinediones [TZDs]). Together, these agents dominated the 2007 type 2
diabetes market with more than $5 billion in major-market sales.
Decision Resources’ Physician & Payer Forum survey
"Avandia One Year Later--A Physician and Payer Perspective" shows how the
landscape of the type 2 diabetes market and dynamics of clinicians’ prescribing
behavior will continue to shift as the medical community makes sense of the
aftermath of the meta-analysis. We surveyed 70 primary care physicians (PCPs),
74 endocrinologists, and 20 managed care organization (MCO) pharmacy directors
regarding their perceptions of how Avandia and Actos have weathered the storm,
and how the TZD safety warnings have affected Amylin/Eli Lilly’s Byetta
(exenatide) and Merck’s Januvia (sitagliptin) in particular.
This study allowed Decision Resources to understand physicians’
and MCOs’ attitudes and clinicians’ patterns of use of the TZDs, GLP-1
analogues, DPP-IV inhibitors, and fixed-dose combinations in the type 2 diabetes
market:
- Understand the extent to which data on the cardiovascular
safety of Avandia and Actos has affected physicians’ prescribing habits for the
PPAR-gamma agonists. Do clinicians consider the long-term cardiovascular safety
issues to represent a class effect? How will prescribing for these agents and
competing drug classes evolve over 2008?
-What are physicians’ perceptions of the best and worst
antidiabetic agents in terms of overall efficacy, safety, and convenience? How
do physicians rate individual agents with respect to their propensity to cause
congestive heart failure, weight gain, and hypoglycemia?
- Determine whether the willingness of MCOs to reimburse for
Avandia and Actos has changed over the past year? Are MCOs actively attempting
to shift patients away from Avandia by changing reimbursement policies?
- Understand what impact additional safety data will have on
the prescribing of the TZDs, and on formulary tier status for antidiabetic
agents.
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