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 AstraZeneca is relying on Brilinta, which it believes can sell $3.5
billion annually by 2023, to help offset a wave of patent losses on
older drugs. The product was a central plank in its defense against
a takeover bid by Pfizer last year.
Key to Brilinta's success is widening its use beyond acute care to a
broader group of heart patients -- something the large
21,000-patient clinical trial showed was possible as it cuts heart
risks significantly, albeit at the price of more bleeding.
Shares in the drugmaker, which rose last week ahead of presentation
of the PEGASUS trial at the American College of Cardiology annual
meeting, slipped back on Monday before recovering as investors
digested the results.
Citigroup analyst Andrew Baum said the results were "good but not
great", while Seamus Fernandez of Leerink said the outcome was "far
from an epiphany" for cardiology medicine.
Encouragingly, there was no excess of fatal or irreversible bleeding
into the brain with long-term Brilinta use, which would have been a
serious deterrent against its use.
But an editorial in the New England Journal of Medicine was cautious
about Brilinta's potential, noting that for each 10,000 patients
treated, it would prevent 42 cardiovascular events annually but
cause 31 major bleeds, which was described as "close to an even
proposition".
The current standard care for patients more than one year on from a
heart attack is aspirin alone to prevent clotting, but AstraZeneca
wanted to prove the case for dual therapy by adding Brilinta to the
mix.
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The editorial said the data would "prompt speculation as to whether
dual platelet inhibition with high-potency agents is approaching the
point of diminishing returns".
In practice, many doctors may be selective about using Brilinta and
some will likely opt instead to use Sanofi and Bristol-Myers
Squibb's older drug Plavix, since it is now available as a cheap
generic.
Richard Parkes of Deutsche Bank said long-term Brilinta use was
likely to be limited to highly selected patents with low risk of
bleeding complications and particularly high cardiovascular risk.
Analyst forecasts currently suggest Brilinta sales of $1.5 billion
by 2020, against $476 million in 2014, according to Thomson Reuters
Cortellis.
(Reporting by Ben Hirschler, editing by Louise Heavens)
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