ICI/STUART’s ZESTRIL OUTPACED MERCK’s PRINIVIL IN 1989 RETAIL PHARMACY SALES -- PDS; VASOTEC IS MARKET LEADING ACE WITH PHARMACY SALES OF OVER $300 MIL.

U.S. retail sales of ICI/Stuart's ACE inhibitor Zestril more than tripled in 1989 to $45.8 mil. (based on retail acquisition cost), according to 1989 marketing information from the prescription audit firm Pharmaceutical Data Services. Based on PDS' retail pharmacy sales figures, Stuart's Zestril brand of lisinopril outgrew Merck's Prinivil brand of the once-a-day ACE inhibitor. Zestril retail pharmacy sales at acquisition cost grew 244% in 1989 representing over $32 mil. in new retail sales from 1988. Prinivil retail pharmacy sales grew by 200% to$36.1 mil., representing a $24 mil. sales increase. Total sales for ACE inhibitors in the 1989 U.S. retail market rose 27.8% to $750 mil. with 30.8 mil. prescriptions dispensed, PDS VP Michael Ira Smith reported March 16 at the firm's annual New York City review for drug industry analysts. Zestril had a 6% dollar share of the market and an 8% share of prescriptions, while Prinivil held a 5% share of the dollars and 6% of scripts. Both Zestril and Prinivil were launched in January 1988 with heavy promotions to pharmacists and physicians; Zestril's edge is noteworthy as evidence of ICI/Stuart's strength in the U.S. cardiovascular market; ICI also has the leading selling beta blocker Tenormin. ICI's apparent early victory in the Zestril/Prinivil battle may also reflect the higher profile Merck is giving its market-leading ACE inhibitor Vasotec. ICI/Stuart's "Resolutions" MD education program may have been a factor in Zestril's early lead. The program, begun in February 1988, suggests Zestril's once-daily dosing may be an answer to patient compliance problems. Pricing does not seem to be an issue. Zestril was launched in early 1988 at a discount to Prinivil, but Merck quickly moved to reduce Prinivil's pricing some 21%-27% to get in line with Zestril ("The Pink Sheet" Jan. 18, 1988, T&G-4). ICI/Stuart gained the rights to co-market lisinopril from Merck in 1986 in return for rights to ICI's aldose reductase inhibitor ponalrestrat, which Merck planned to market as Prodiax and ICI as Statil. Two months ago ("The Pink Sheet" Jan. 22, T&G-5), Merck and ICI announced they were phasing out ponalrestat's development because of problems showing efficacy in clinical trials. Commenting on the demise of ponalrestat, PDS' Smith said: "I guess hindsight being 20/20 today...possibly Merck gave up eight share points" from prescriptions in the lucrative ACE inhibitor market. Nonetheless, Merck still has the lead in the ACE inhibitor market. Vasotec, the combo diuretic Vasoretic, and Prinivil combined accounted for more than half of the 30.8 prescriptions dispensed for ACEs in 1989 and, together, generated approximately $383 mil. in retail sales, according to PDS. [EDITORS' NOTE: PDS' figures are usually lower than the sales figures reported by pharmaceutical companies. PDS measures sales to end users (actual prescriptions dispensed) and the retail figures do not include sales to hospitals or institutional purchasers.] Meanwhile, the large slice of the market held by Capoten (captopril) and the diuretic Capozide shrunk last year, with Zestril and Prinivil carving out more of the Bristol-Myers Squibb pie in 1989 than Vasotec. Capoten/Capozide's prescription share dropped by 8 percentage points in 1989 while the overall ACE inhibitor market (measured by prescriptions dispensed) increased 25%. In 1989, Capoten/Capozide had a 43% combined share of the retail prescription market versus a 51% share in 1988. In retail pharmacy sales at acquisition cost, Vasotec outpaced Capoten with a 27.8% sales gain to to $313.1 mil. in 1989 compared to Capoten's retail sales of $294.4 mil., up 8%. For the heart drug category as a whole, the share of the market held by ACE inhibitors increased by five percentage points to a 21% share of the market. Overall cardiovascular drug product sales in retail pharmacies grew 5.4% to $3.9 bil, according to PDS. * Among oral calcium channel blockers, Marion Merrell Dow's Cardizem continues to hold the lion's share, with 37% of the 38.6 mil. scripts and 41% of the $1.044 bil. sales market. Cardizem had $425 mil. in U.S. retail pharmacy sales, putting the drug second behind Glaxo's anti-ulcer drug Zantac in PDS' "Top 10" selling prescription products in the U.S. ("The Pink Sheet" Feb. 19, T&G-2). Based on PDS percentage shares, Pfizer's Procardia had about $281 mil. in sales, two share points lower than in 1988; Cardene (Syntex), Calan (Searle), Knoll's Isoptin and generic verapamil made up the rest of the calcium channel blocker market. Calan gained four percentage points in 1989, with retail sales of approximately $230 mil.; Cardene, on the market for nine months (see box below for 1989 new product launch retail sales) grabbed a 1% share of the market, or about $8.5 mil.; Isoptin held steady at 6% (about $63 mil.) and generic verapamil made up the difference with 3% ($31 mil.), down from a 5% share of the$856 mil. market in 1988. Smith called sustained-release products the "secret of success" for oral calcium channel blockers. PDS estimates that extended-release dosage forms generated 33% of the $1.044 bil. category "up about 10 share points from 1988 and [for] 1990, we would estimate that it is likely to approach 50%," Smith said. PDS put sales of Upjohn's 1989 anti-arthritic entry Ansaid at $43.5 mil. in 11 months on the market. Flurbiprofen is doing about $4 mil. in sales per month, not a bad showing considering the anti-arthritic market was virtually unchanged at $1.3 bil. and 39 mil. scripts. Voltaren was the fuel that put Ciba-Geigy eighth in the PDS "Top 10" list of companies. Ciba's U.S. retail pharmacy sales were up 25% to $796 mil., the biggest gain among the "Top 10." In its second year on the market, Voltaren sales were $212.8 mil., according to PDS. Janssen's non-sedating antihistamine Hismanal is also pulling in about $4 mil./month, with 1989 sales of approximately $44 mil. after 11 months on the market. Marion Merrell Dow recently reported that manufacturer sales of its nonsedating antihistamine product Seldane topped $300 mil. in 1989 ("The Pink Sheet" Jan. 15, p. 12). The "Top 10" list of products sold to hospitals (as measured by patient use) put Roche's Rocephin as the topselling hospital product in 1989. Roche proclaimed the once-a-day injectable antibiotic's dominance in its 1989 statement, saying the drug had "enjoyed a 42% increase" in 1989 sales, putting Rocephin sales at industry estimates of about $260 mil. ("The Pink Sheet" Jan. 22, p. 6). Joining Rocephin (in descending order of sales) in the PDS "Top 10" were: cefazolin, Merck's Mefoxin; vancomycin, Glaxo's Zantac; ceftazidime (Glaxo, Lilly and SmithKline Beecham); Genentech's TPA product Activase; clindamycin, Merck's Primaxin and Hoechst's Claforan. PDS' Smith noted that, for the first time in the three years his service has been tracking hospital product use, SmithKline's Tagamet did not make the "Top 10." In response to a question about the rapid rise in the size of the hospital market, (up 18% in 1989 to $6.5 bil.), Smith pointed out that "a large percentage [of the growth] was due to TPA," which had manufacturer sales of about$196 mil. last year, but will face additional pressure in 1990 from Eminase and the streptokinases.