>They only have to get aggrastat to about 30 million by taking share from integrilin and reopro.<
One would think that Merck would have the capabilities, resources, and cash to market Aggrastat much more effectively than Medicure, yet they failed miserably.
That's not to say Aggrastat isn't a perfectly good drug. It is. But Medicure has to be willing to spend big bucks to compete in the GP IIb/IIIa market to take any market share away from either Integrilin or ReoPro. And they need experienced marketing professionals on staff. Do they have the money and staff to do this right? Doubt it.
Here's where the opporunity exists for Aggrastat: because it is relatively cheap, they could focus on the benefits of use with bivalirudin, particularly in higher-risk patients (bivalirudin is currently indicated only for elective PCI). Neither Integrilin nor ReoPro has a chance for combined use because of their high cost.
I doubt the combination of bivalirudin and Aggrastat will reduce short-term adverse outcomes signficantly. However, they need to focus on subclinical events (eg, mild periprocedural elevations in CK-MB and other cardiac markers) and raise awareness around the impact of these events on long-term outcomes.
They won't necessarily need to run new trials; they may be able to mine existing data for this information.
Medicure also needs to provide clear information on dosing. Because there were some issues with dosing in early trials, there is still the perception that the proper dosage remains to be determined.
Cost efficacy vs both other GP IIb-IIIa and bivalirudin should also be addressed.
They also need to clearly differentiate Aggrastat from bivalirudin. Seems like a no brainer since bivalirudin is an anticogulant and Aggrastat is an antiplatlet, but some physicians seem to think they're interchangable. Anticoagulation is not enough.
And one more thing...they can make a big deal about the short half-life of tirofiban relative in particular to ReoPro. Because the Medicines Company has made a big deal out of bleeding with GP IIb-IIIa inhibitors, the ability to withdraw the drug and rapidly get it out of the patient's system is a big plus...as long as they are clear on the impact of renal function on clearance.
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