Friday, January 24, 2014

DTC Melee–a-Trois: Pradaxa, Xarelto, and Eliquis. Women Only Marginally Involved.

Why does it always seem that pharma direct-to-consumer (DTC) advertising competition for market share comes in threes, or as I like to say, "DTC Melee-a-Trois"?

Click on image for larger version.
Last year around this time, I wrote about three companies competing for diabetes market share (here). The diabetes drugs squaring off in that melee were Januvia, Onglyza, and Victoza. To win over consumers, each implemented an online content marketing campaign that featured recipes from celebrity chefs.

My thought at the time was that none of the drugs had an efficacy advantage, so each had to engage in a battle reminiscent of Food Network's Iron Chef.

Today, I read about Pradaxa, Xarelto, and Eliquis, which are fighting for a share of the atrial fibrillation (AFib) market (see "The Warfarin Replacement Ad Fight").

Unlike diabetes, AFib cannot be mitigated via change in lifestyle. Therefore, there isn't much opportunity in this therapeutic area to engage in any kind of popular content marketing. There's only so much content you can create and curate that is relevant to AFib.

So how are marketers at Boehringer, Janssen (J&J), and BMS positioning their respective expensive anti-AFib Rx drugs -- Pradaxa, Xarelto, and Eliquis, respectively  -- to compete with warfarin -- an inexpensive generic drug?

In this case, each drug has a common foe: warfarin, which is a generic drug that was first approved for use as a medication in 1954 and has remained popular ever since. According to Wikipedia, "warfarin is the most widely prescribed oral anticoagulant drug in North America." Each marketing campaign focuses on warfarin's Achille's heel: it requires frequent monitoring to make sure the levels are correct. "For elderly people," says Bob Ehrlich (op cit), "going to the doctor frequently to get a blood test is a pain, literally."

Aside from that, however, each online DTC campaign uses similar imagery of an elderly couple (see collage above) and the patient is the husband (or father).

I learned from an article in the J Am Coll Cardiol (here) that an equal number of women and men suffer from AFib, which usually occurs in people over 75:

"In all age groups, men have a higher incidence of atrial fibrillation than women. However, because the incidence of atrial fibrillation increases dramatically with age and because there are more women in the population older than the age of 75 years, the absolute number of women and men with atrial fibrillation in this age group is equal."

So, why are women only portrayed as caregivers and otherwise "left out of the [Afib] picture" in these ads?
An interesting sidebar: Some time ago, Boehringer was cited for dirty fighting when it violated Clauses 2, 9.1, 3.2, 22.1 and 22.2 of the ABPI (Association of the British Pharmaceutical Industry) Code of Practice.

The case involved newspaper articles that referred to Pradaxa as a "super pill" and a "revolutionary drug." The stories also dissed the competition (warfarin) by referring to it as "rat poison" (see "BI Masters the Art of WOM through Its 'Parrots,' er, Spokespersons").


  1. Warfarin IS rat poison.

    As somebody who has AFib, and who has gone through the cardiac ablations and the final "cure" of pacemaker, taking Warfarin for all that time, I can say that warfarin sucks. After two years of the drug, I was constantly cold, and certainly tired of the monthly trip to the doctor's office. A normal Floridian winter (I'm an Ohioan), and I'm bundling up, I can't keep warm. Being out in 90 degree weather felt absolutely like 70 does now. Because I take Pradaxa.

    But I'm not in my 70s either. Not having a reversal solution for Pradaxa is a bit of a worry, but it looks like there is at least one coming this way. And quite frankly, the bleeding that would happen from small cuts that I would see from taking warfarin doesn't happen with Pradaxa.

    I do not represent Boehringer, I do not get any compensation from them or anybody else, I am simply a customer that takes the drug and sees a lot of improvement from taking it. Even with the minuses of costing much more than warfarin and having to take the pills directly out of the bottle instead of in the pill kit with the rest of my meds.

    1. Yes, the active ingredient in some forms of rat poison IS warfarin. No one is saying it isn't. And all the side effects you are having may be due to warfarin. You have to go to the original parrot post to understand that what I am pointing out is that news reporters are being influenced by pharma companies and sometimes in ways that violate the industry's own guidelines.

  2. If Warfarin is rat poison, does that mean that Pradaxa is more safer to take?


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