Biotech Values

[urche]

Future niche for enoxaparin--reassurance and rebuttal needed!

Excuse me, because I know this has been addressed before here. But, as I try to grapple with the newer, oral anticoagulants that have arrived and will appear imminently on the market, I am getting concerned about the likelihood of shrinking role for enoxaparin.

JNJ is seeking approval for Xarelto (rivaroxaban) and Pradaxa already is on the market for prevention of strokes in atrial fib. That market mostly will impact warfarin. But, as clinicians get comfortable with the ease of using those drugs and relative safety, I expect to see off label use.

More of a direct threat to enox/MNTA/TEVA, apixaban is seeking approval for prevention of DVT following orthopedic surgery, and may even be superior to enox. Xarelto results in this indication also look good. Furthermore, Xarelto is being evaluated for prevention of VTE in medically sick (bedridden) patients.

If all these enoxaparin indications are infringed upon, there would not be much of its niche left intact except for immediate anticoagulation in situations such as bridging prior to surgery, initial therapy for pulmonary embolism, and arterial thrombosis.

Are my concerns misguided?

Urche