Since then we have seen the arrival of several new classes of drugs for the treatment of this condition, the beta-blockers, Calcium Antagonists, ACE inhibitors and most recently the AIIAs, or the Angiotensin II Receptor Antagonists. AIIAs provide excellent control of blood pressure, and unlike other agents which have gone before them, have almost placebo-like tolerability.

In the UK, MSD were first to market early in 1995 with the highly successful drug Cozaar (losartan). Cozaar managed to develop and grow its own market, and opportunities increased rapidly in the first years after launch. Seven years on and with six products fighting for opportunities within this market place, Sankyo are due to launch their own AIIA, olmesartan. Recent papers have shown strong results for olmesartan (Benicar), indicating a superior blood pressure lowering capability over older AIIAs such as Cozaar (Source: Journal of Clinical Hypertension - Oct 2001). Physicians will have greater treatment choice, but how much of an impact will Benicar make in this crowded market place?

It is interesting to look at Cozaar, firstly against the other three main AIIAs, Aprovel (BMS-Sanofi), Amias (AstraZeneca-Takeda) and Diovan (Novartis), and secondly against the two newest AIIAs, Micardis (Boehringer Ingelheim) and Teveten (Solvay). We can use Launch Essential to examine the three key parameters of launch success - awareness, detailing and prescribing, for the products in this interesting market.

All AIIAs achieved high levels of awareness immediately post launch. Their marketing campaigns were so strong that between 60 and 70% of UK GPs were aware of every AIIA within 6 months of the products launch. Later in the launch cycle, Diovan was the greatest performer, achieving 90% awareness after 2 years. Interestingly, Micardis was the only AIIA not to increase its awareness in the second year post launch.

Turning to look at post launch detailing in this market, we can see how promotion from Novartis exceeded the efforts of the other corporations. Over 80% of UK GPs had been detailed in the first 12 months post launch, compared to 65% for Aprovel and Amias, and 50% for Cozaar and Teveten.

Finally, and most importantly, how did this high awareness and high levels of detailing relate to the uptake of each product?

Looking at GP prescribing, in the first twelve months post launch we see Aprovel's performance outstripping the others in the class. Second to market, Aprovel had a large user base after 12 months of around 32% of UK GPs compared to the 20% enjoyed by Cozaar and Amias. In the second year post launch, Cozaar steadily increased their user base as did Amias and Diovan but to a lesser degree. It is interesting to note that Diovan, which achieved the highest awareness and detailing of the AIIAs in the two year period post launch, performed the least well in terms of the proportion of GPs using in the same period, compared to Cozaar, Amias and Aprovel (the four main AIIAs and the first four to market).

Micardis and Teveten, launched within four months of each other but two years after Amias, have been less successful. Although almost matching the other AIIAs in terms of awareness and detailing, the proportion of GPs using these products has been consistently low. After the first 12 months, Micardis achieved usage by 16% of UK GPs, and Teveten by only 5%. On this basis, what will the outlook be for olmesartan, launching over two years after Teveten?

We now turn to Jigsaw to look at current opportunities within the AIIA market.

In the first years after the launch of Cozaar until early 1999, there was steady growth in the market for AIIA opportunities. From 1999 until earlier this year, that growth declined, and opportunities averaged about 17,000 per month. Since the beginning of this year we have seen a remarkable increase in opportunities, from under 20,000 to over 30,000 in less than six months.

So what is driving this upsurge in business for the AIIAs and who are the beneficiaries? In March 2002, the LIFE trial (Losartan Intervention for Endpoint reduction) concluded that Cozaar was more effective in reducing the combined end point of death, heart attack and stroke among hypertensives than the beta blocker Atenolol, due to the decreased risk of left ventricular hypertrophy. This data had an enormous impact on Cozaar, doubling the number of opportunities per month from a steady level of around 4000 to just less than 8000. However, the gains were not only for Cozaar. In the period from January to May 2002, Aprovel opportunities grew by 75%, and Amias by over 100%. This seems to say that the AIIAs are viewed as a class, but the class effect appears only to extend to three or sometimes four members of the class. These four were the first four to market and have monopolised the share of opportunities, with Micardis and Teveten struggling to maintain a much smaller share of the market.

So what does the future look like for new entrants within this market? It seems that a high level of detailing is required to maintain the smallest of market shares. A successful launch for Sankyo will be down to an excellent marketing campaign, and Sankyo are certainly looking forward to the future "…when olmesartan is launched into the market place, it will be supported by impressive data collected from a global program of clinical and preclinical studies. This data will convince our customers that olmesartan's excellent efficacy and safety profile, as well as additional vascular protective effects, make it a first class choice for the management of a hypertensive patient." (www.sankyo.co.jp). We will certainly be watching this market with interest.

About the author

Isis Research plc is the parent company of Isis Research, Fieldwork International and Maxis Research. Isis Research has its global and regional headquarters in London. Working together with our affiliated companies, Fieldwork International and Maxis Research, we can provide our clients with all their healthcare market research needs - from early product development through to sales force effectiveness; fieldwork and data processing in one integrated package.

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