MRK/odanacatib
It's hard to compete on efficacy in the osteo market because BMD readings are typically only done once every 2 years, so you basically give the drug and assume that it works if the patient can tolerate it. Obviously, if a patient fractures then you know it didn't work very well.. but triggers for therapy change are primarily cost, convenience and tolerability, not efficacy. This is part of the reason why Prolia stumbled despite very good data vs. bisphosphonates. Another reason is the "biologic" halo of cancer risk, which may or may not apply here depending on what the safety issues are (primary care physicians are very risk averse when it comes to cancer). And the convenience benefit (once weekly) isn't anything to write home about, especially when there is no H2H data against an equally convenient bisphosphonate. Add continuous generic pressures and I'm not at all convinced that this is a game changer.
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