Looking at the prescribing information for Rasuvo and Otrexup, I think Otrexup has a few aces up its sleeve compared to Rasuvo, which, with the head-start on launch, should keep it ahead commercially.
Antares has mentioned a 25 rep salesforce while Medac is recruiting 27 reps. But, Leo has a 75 rep salesforce for psoriasis, which gives an advantage to Otrexup.
Antares will have at least an 7-8 months head-start (mid-January Otrexup launch vs. Sep/ Oct Rasuvo launch, as Medac needs time to recruit and train its new salesforce).
Added to the differences in products characteristics, this should give an advantage to Otrexup.
The prescribing information is essentially the same boiler-plate for both, but some differences exist, in particular in the User Instructions part:
1 - shelf-life:
Rasuvo's is 17 months.
Otrexup's is 24 to 33 months (24 for 10/15 mg and 33 for 20/25 mg).
= At least 7 more months before need to be returned or thrown away.
2 - dose-strengths/ SKU:
Rasuvo has 10 going from 7.5 to 30 mg in 2.5 mg increments.
Otrexup has 4 going from 10 to 25 mg in 5 mg increments.
= Not sure if 2.5 mg increments would really change the life of rheumatologists and patients vs. 5 mg ones.
= Not sure if 27.5 and 30 mg doses critical vs. 25 mg.
3 - PK/ Bioavalavility:
Rasuvo: healthy subjects, 7.5 to 30 mg exposure 35 to 68% higher than oral MTX; psoriasis, 30 mg exposure similar IM.
Otrexup: rheumatoid arthritis patients under oral MTX for at least 3 months, 10 to 25 mg exposure 13 to 36% higher than oral MTX, also similar abdomen or thigh.
= Not sure if one is better than the other in absolute. Still, I think a rheumatologist would find RA data in patients already under oral MTX more pertinent.
= Note “significantly enhanced bioavailability” was highlighted by Medac in this morning’s PR.
4 - Needle visibility:
Rasuvo has a visible needle.
Otrexup neddle is hidden.
= Needlephobia could have influence in patients using a non-oral drug for the first time.
5 - Device activation:
Rasuvo: pull bottom cap straight (do not twist), push firmly against the skin to unlock safety.
Otrexup: twist bottom cap, flip top safety clip.
= Not sure if significant other than the two modus operandi are not exchangeable.
6 - Injection-site preparation:
Rasuvo: clean, "pinch a pad of skin with your thumb and forefinger of your free hand by gently squeezing. Patients with rheumatoid arthritis who are unable to pinch the skin can inject directly into the thigh without pinching if needed."
Otrexup: clean only.
= Otrexup simplest.
7 - Injection:
Rasuvo: press top button, once click heard count to 5.
Otrexup: push firmly till click heard, count to 3.
= Not sure if significant other than the two modus operandi are not fully exchangeable.
Taken together, 5- device activation and 7- injection seem easier for Otrexup.
