MUMBAI - Marketing of patented and branded drugs is a relatively new concept in India but going by the initial strategies put into play by multinational companies - most notably for the DPP-4 inhibitors Januvia (sitagliptin), Galvus (vildagliptin) and Onglyza (saxagliptin) - it has all the ingredients of blowing up into an all out war in the race to capture the mind recall of doctors.

Launched in 2008, Januvia has been a successful brand for Merck's India affiliate MSD, riding on its unique principles of "responsible pricing" coupled with a broader disease management approach - a hitherto untried concept by MNCs - and a few marketing consultants now recognize that Merck's launch ideas could set a benchmark when introducing new branded products in India.

Swashraya Shah, medical director, MSD, said that Januvia is firmly established in the Indian market as the first DPP-4 compound, but the task is far from complete.

"We not only have a head start in bringing Januvia into the market, but also in initiatives aimed at supporting physicians to improve treatment outcomes in their patients."

Januvia has earned wide recognition by winning best brand awards from the Organization of Pharmaceutical Producers of India and is tipped to have grossed millions of dollars in a short span of time (Also see "Merck Vows To Be In Top Five In India By 2015; Push Will Come From 13 New Launches In The Next Two Years" - Scrip, 23 February, 2009.). MSD officials were not keen to share the exact numbers.

Selling Drugs And Managing The Disease

Among some of the patient care programs for Januvia, MSD has on offer free diagnostic tests as well as consultations on lifestyle and diet through its online services Sparsh Healthline (meaning "touch" in Hindi). This, experts said, allows MSD to offer more than just the drug and is seen by doctors as extraordinary patient friendly moves. Sparsh has been able to network with more than 2,500 patients and 4,500 diabetes experts who are roped in for periodic counseling programs from its Hyderabad-based call center.

Underplaying rival pressure and launch of competing products, MSD's Shah says, "We are confident of bringing in more innovations to existing disease management programs and beyond that will continue to differentiate us in the market. We will constantly strive to become the preferred partner to physicians in the battle against diabetes." There was no mention of what is coming next in keeping the leadership.

IMS Health sales audit data shows that the top 35 metropolitan Indian cities contribute more than 85 percent of the total sales of the leading DPP-4 product. "It is a fast-expanding brand and could be expanding in smaller towns and cities soon," says Mahesh Kalsekar, principal, Commercial Effectiveness, IMS Health.

Stiff Competition But More The Merrier

But competition will be stiff in the diabetes space, which is seen as the biggest emerging market segment in India standing at $350 million and growing annually at 20 percent. Onglyza (saxagliptin) launched jointly by Bristol Myers Squibb and AstraZeneca's is also expected to clock decent growth by analysts.

IMS Health's Kalsekar said it will be interesting to see how Onglyza manages to establish itself in a market dominated by the entry leaders especially in the light of the specialty focus of BMS in diabetes and AZ's existing franchise in the cardiology segment.

More so, because the DPP-4 inhibitor market is at the nascent stages in India and very selectively prescribed by medical experts. IMS Health'data shows not more than 10 percent of the total doctors who prescribe traditional anti-diabetes drugs like sulfonylurea and metformin would be prescribing these molecules and that in truth is reflected in the share of prescription that those compounds generate.

"One prescription of DPP-4 molecule is 5 to 7 times that of traditional molecules in terms of value. So even if we see good value for [the] DPP-4 market now, it does not result in any major switchover in terms of patients or prescriptions. Secondly, the anti-diabetic market is growing at a fast pace with many new patients being diagnosed. This may create a new patient pool for the segment," said the IMS Health expert.

Karnvir Mundrey, who heads Bangalore-based Atharva Lifesciences Consulting concurred, noting that newer global brands will be launched through differentiated strategies for addressing a wider base.

Docs Say Good Drugs But Pricing Is Key

Even at one-fifth of their pricing in India as compared to the U.S., reaching out to the wider mass of patients could be a major challenge and may explain the larger market share that the few compounds have in the urban centers of Mumbai, New Delhi and Bangalore.

Ashok Jhingan a well-known diabetes specialist based in New Delhi said that the late-stage detection of the disease in India is one of the reasons for a slower pick up in newer medicines. On average, Indian patients are detected of having diabetes at least five years after onset of the disease, Jhingan said.

He compared the DPP-4 compounds with other traditional segments and said patients may not be put on the new products even if there are additional benefits such as being weight neutral that the companies claim.

"It makes sense to put a new patient on the first line regimens and then look at options like insulin because at a later stage, it may become necessary anyways. Moreover, it could be too taxing to afford a single tablet worth 42 rupees for many patients with poor economic backgrounds while there may be a considerable number of patients showing keenness to be put on more effective therapies," Jhingan said.

When asked about his preference among MNC strategies. he said he favored Novartis' plan to sell Galvus (vildagliptin) in 50 mg dosage forms and making it more affordable.

Jhingan was, however, critical of doctors leaning in favor of MNCs in promoting their products despite knowing that those drugs are priced high for an average Indian patient. "They [doctors] should be more patient friendly rather than industry friendly," Jhingan cautioned.

Savvy Strategies, Greater Growth Avenues

Novartis has devised a dual marketing strategy for its Galvus (vildagliptin) brand in tying up with Indian diabetes drug heavyweight USV. While USV is mainly concentrating on the smaller cities as part of a co-marketing deal with the Swiss pharma giant, Novartis itself has devoted its field force to the larger cities.

"Sales of Galvus have been progressing well since [the] launch and have in fact done better than what was initially planned," Novartis Managing Director Ranjit Shahani explained optimistically. "We believe that we have sufficient associates in the field to cover our target audience for Galvus."

In India Galvus comes in 50 mg or 100 mg daily doses (in two divided doses of 50 mg) in monotherapy and in dual combination with metformin, a TZD or insulin, in combination with a sulphonylurea.

MSD's Shah is keen on keeping a tab on the pricing trends but said that prices cannot be considered to be the only factor in maximizing treatment outcomes for patients.

"While bringing down cost is a way of improving access to treatment for patients, it is not the only way to improve treatment outcomes. We will not shy away from any opportunity that will enable us to provide the true value to physicians and patients towards improving treatment outcomes in diabetes," he observed.

For some time, PharmAsia News has learned MSD is toying with the idea of manufacturing Januvia in India and scale down prices further to gain a much wider margin over its newer competitors but on record this was not substantiated by MSD officials.

Though late in the game, BMS and AstraZeneca joined forces in April for the launch of its newest blockbuster hope Onglyza. The two companies are expecting strong numbers at the back of the inherent advantages of the product - being weight neutral and devoid of hypoglycemia side-effects.

It is learned that AstraZeneca and BMS are ramping up their field staff to connect with doctors in the big and medium-sized cities, but the companies did not respond to a request for comment on the strategies for Onglyza.

Naveen Rao, MSD's former managing director in India had once remarked that the Indian pie of the diabetes market is very large and there is enough for everyone. But for the future it will be important to see which companies succeed in winning doctors' loyalties and servicing patients. "A three-way fight brings the best to a patient," a senior marketing executive noted.

- Vikas Dandekar (v.dandekar@elsevier.com)

Big Brand Fights Come To India As Januvia, Galvus And Onglyza Vie For Market Share

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