The warfarin-replacement market has been bracing for the entry of Eliquis since well before the drug won FDA approval in December, as it stands to benefit from stronger pre-market vetting and lessons learned from earlier-to-market competitors.
Boehringer Ingelheim's Pradaxa, approved in 2010, has seen a steady uptick in sales, with 2.6 million US prescriptions bringing in $827 million last year. J&J/Bayer's Xarelto, approved in 2011, has seen a lower trajectory, pulling in $200 million on 818,000 US prescriptions last year.
Now comes Eliquis. Leon Henderson-MacLennan, a principal at research firm inThought, told MM&M that rigorous clinical trials make it clear “Eliquis is destined to be a preferred anticoagulant of choice,” thanks largely to clarity about which patients it's most appropriate for.
Pradaxa has struggled with a clear delineation about who should take it, and has been dogged by dissonance between the bleeding risk shown in clinical trials and that found in the real world. Although the FDA said in November that Pradaxa was not associated with a higher bleeding risk than warfarin, MacLennan said concern has made people “less inclined at least to switch patients from warfarin to dabigatran.” (Physician KOLs with whom MM&M spoke said that drugs in the category are generally well tolerated.)
Leerink Swann analyst Seamus Fernandez wrote in a January investor note that he expects Eliquis will be a “relatively slow initial launch that picks up over time.”