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Bristol-Myers Squibb (NYSE:BMY) in collaboration with Pfizer (NYSE:PFE) developed Eliquis, a drug for preventing blood clots in patients with atrial fibrillation. The drug was approved by the FDA in December 2012 and garnered a lot of enthusiasm with peak sales estimated to reach almost $4 billion over 4-5 years. However, it seems that the drug is facing some problems in initial uptake. At $12 million, its sales in Q2 2013 were significantly below expectations and were even lower than $22 million recorded in the first quarter of its launch (Q1 2013).
In this article, we will discuss the problems that the drug is currently facing and why we are still optimistic about its future.
Eliquis Was Late To Enter The Market
Eliquis was initially scheduled to receive the FDA’s blessings in March 2012. However, the regulatory body postponed the approval twice and gave the green light only at the end of 2012. It suspected that some of Eliquis’ clinical trial data had been tampered with at a test site in China and required more time to reanalyze the available data. 
Meanwhile, competing drugs such as Xarelto (developed by Bayer AG and Johnson & Johnson) and Pradaxa (developed by Boehringer Ingelheim) entered the U.S. market and carved out a niche for themselves. Eliquis is currently having a tough time to gain acceptance because many patients and doctors have already become accustomed to these drugs.
Eliquis’ Dosage Is Tougher To Follow Compared To Xarelto
Eliquis is a twice-a-day drug whereas its arch-rival Xarelto requires patients to consume just one pill a day. Although this may sound like a small difference, it is an important factor that medical practitioners consider when prescribing a drug. A simpler regimen ensures that a larger number of patients follow recommendations correctly. According to one recent study, roughly two-thirds of American adults are unable to take their medications as per prescription. 
However, We Are Still Hopeful About The Drug
Even though the initial response to Eliquis has been mild, we think it is too early to lose hope. The drug has a much better clinical profile than both Xarelto and Pradaxa and is likely to gain market share once medical practitioners become aware of its benefits. Out of the three drugs, it is the only one which can reduce the risk of death in patients with atrial fibrillation (heart rhythm disorder). It is also better at reducing the risk of excessive bleeding, a major concern for patients who use blood-thinners. 
|Risk of stroke or embolism (efficacy)||-34%||-12%*||-21%|
|Risk of death (all-cause mortality)||-12%*||-8%*||-11%|
|Risk of major bleeds (safety)||-7%*||+4%*||-31%|
|* Not statistically significant|
|Sources: RE-LY (Pradaxa), ROCKET-AF (Xarelto) and Aristotle (Eliquis) trial data; Mark Schoenebaum/ISI Group; MMM Online|
For their part, Bristol-Myers and Pfizer are leaving no stone unturned. Bristol’s management recently stated that it will now reach out to physicians in key U.S. territories through medical, educational activities and explain its benefits. They will also launch a direct-to-consumer marketing campaign in Q3 2013 to increase awareness about the drug among end consumers. The drug’s sales are also likely to increase outside the U.S. in the coming years as Bristol plans to launch the drug in nine additional countries by the end of this year. Notes:
- Chinese Trial Misconduct Delayed Bristol-Myers Medicine, Bloomberg, July 9, 2013 [↩]
- Lack of Medication Adherence Harms Americans’ Health, Greenberg Quinlan Rosner Research, May 2, 2013 [↩]
- Eliquis stacks up better than Pradaxa or Xarelto, MMM Online, August 30, 2011 [↩]
- Bristol Myers Squibb Co. CEO Discusses Q2 2013 Results, SeekingAlpha, July 25, 2013 [↩]