If there is one market at the moment that is full of activity with excellent prospects for growth it is the NSAID market. The years 1999 and 2000 saw two of the most successful UK launches with Vioxx/rofecoxib and Celebrex/celecoxib. These two compounds are Cox 2 inhibitors and are a revolutionary type of NSAID. Almost all patients with Arthritis or chronic pain will be prescribed an NSAID but traditional NSAIDs were associated with high levels of GI side effects. Cox 2 inhibitors, however, are so specific to the anti-inflammatory pathway that GI problems are seldom reported.

All eyes are currently focused on the new Cox 2 inhibitor from MSD, launched on the 15th April. Coming three years after the very successful launch of Vioxx, it will be interesting to see the impact of Arcoxia on this dynamic market. It appears that Pharmacia will soon be following suit as their follow-up Cox 2, Bextra, has now been launched within the US and will no doubt soon arrive in the UK.

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This article studies the success of the launches of both Vioxx and Celebrex within the UK in order to gain an understanding of how the newer Cox 2's may impact on the existing market place. Two data sources have been used, Jigsaw and Launch Essential, both syndicated services available from the Healthcare Intelligence Systems department at Isis Research.

Jigsaw is a sales force effectiveness tool, collecting data from a robust and representative panel of 400 GPs across the UK. Thus Jigsaw provides a unique link between promotional activity by pharmaceutical representatives to GPs and new business prescribing.

Launch Essential is an advanced usage and awareness tracker that combines the key parameters for launch success in one database. It provides a complete overview of over 500 product launches both past and present.

Looking at the Launch Essential syndicated data source we can see that there is little disparity in the success for Vioxx and Celebrex. We have focused on the twelve months post launch time period and concentrated on the three standard key performance indicators of - GP awareness, detailing and prescribing. Awareness is defined as when the GP becomes aware of a product for the first time via any medium. Detailing is a measure of the number of GPs who have been contacted by medical representative. The prescribing parameter is a measure of the proportion of GPs who have prescribed the drug for the first time.

From Launch Essential the level of GP awareness for Vioxx reached 93% by month 12, this is the highest ever figure recorded on Launch Essential and is 5% higher than the awareness of Celebrex at 88%.

The promotional activity for these two products in terms of sales force details was also high. By month 12, post launch 80% of the panel had been contacted by a Vioxx representative and 76% had been called on by a Celebrex medical representative. This high level of awareness and detailing activity was followed by a fast uptake in terms of usage for these two products. After 12 months on the market 66% of the Launch Essential panel had prescribed Vioxx, 10% fewer had written at least one Celebrex prescription at 56%. The fact that Vioxx was the first to market in a new class and had a full year advantage over the launch of Celebrex may well have contributed to the success of the product in the UK.

We now turn to Jigsaw data to gain an understanding of the dynamics of the Cox 2 market in the most recent 12 months.

Interestingly after such successful launches and the apparent uptake of these novel medicines, Vioxx and Celebrex have a relatively small share of the market compared to older NSAIDs such as ibuprofen and diclofenac. At a comparatively high price, this new class of NSAID will take time to earn the doctors' loyalty. Within the UK, MSD with Vioxx and the new Arcoxia and Pfizer and Pharmacia with Celebrex, are leading the way in expanding GPs awareness and understanding of this exciting class.

One might think that the low market share implies that only a small proportion of doctors are initiating the products. However, both Celebrex and Vioxx have very broad usage amongst the UK GP population, with nearly two thirds initiating a Cox 2 over the last 12 months (Source: Jigsaw). In spite of the high breadth, depth of initiating Celebrex and Vioxx is disappointing compared to some of the other NSAIDs. Diclofenac, for example, achieved an average depth of 20 initiations per GP user, compared to an average of six for Celebrex and Vioxx. Seeing that this market has excellent opportunities for growth with increasing GP awareness and understanding, it will be very interesting to monitor the effect of Arcoxia on new business for the other Cox 2s.

So, how will MSD approach the launch of Arcoxia, after such a successful campaign for Vioxx only 3 years ago? It is interesting to look at the launch of VioxxAcute in September 2001. Focusing on detailing activity for Vioxx, Vioxxacute and Celebrex from April 2001 to March 2002 - at the start of the time period, Vioxx and Celebrex were achieving on average 8000 visits in any given month. With the launch of VioxxAcute we can see MSD's resources being switched from Vioxx. The levels of detailing overall for Vioxx and Vioxxacute exceeded those achieved previously by both Celebrex and Vioxx.

The next few months will be very interesting for the key players in this market place. The market has room for high levels of expansion, and sales of Arcoxia and Vioxx from MSD are forecasted to reach between $2.8 billion and $3.1 billion worldwide by the end of 2002. MSD and Pharmacia/Pfizer are not the only companies with product launches planned within the Cox 2 market. Novartis have a Cox 2 in development with phase III trial results expected in a few months time. These novel Cox 2s are certainly an exciting market to be a part of, and equally intriguing to watch.

About the author

This article was researched and edited by Matthew Pitt, Libby Magril, Alexandra White and Louisa Parson from Healthcare Intelligence Systems at Isis Research.

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