While Xarelto is on Trial Its Competitor Eliquis Gains Ground

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Eliquis was the last new oral anticoagulant to reach the market, but it has steadily made up ground on its rival Xarelto. First-quarter sales of both products confirmed the trend: Bayer (OTCPK:BAYRY) and Johnson & Johnson’s (NYSE:JNJ) Xarelto shrank in the US while Bristol-Myers Squibb (NYSE:BMY) and Pfizer’s (NYSE:PFE) Eliquis beat expectations.
As with many innovative drug classes, both are under price pressure, and the cheaper alternative of warfarin has given payers a point of leverage. At long last, it seems that Eliquis’ safety profile is about to offset Xarelto’s first-mover advantage, though upcoming trial results could help change the Bayer pill’s fortunes.

Billion-dollar quarter
Last week’s first-quarter results calls for Bristol and Bayer offered points of contrast: Bristol crowed about its first billion-dollar quarter and its position as the most prescribed new oral anticoagulant in the US, while Bayer pointed to price pressure and US insurance coverage for its disappointing start of the year.

While Bayer grew its share of Xarelto sales 20%, US partner Johnson & Johnson had prepared the market for disappointment earlier when it reported a 9.5% shrinkage in first-quarter US sales to $513m. J&J said it had increased market share by more than two points, and that new oral anticoagulants had managed to reduce warfarin’s market share from 58% to 51%.

Anticoagulant battle royale
Nevertheless, the Medicare coverage gap known as the doughnut hole, and price pressure from commercial and government channels, had done damage to sales, J&J said.

The Eliquis performance was so impressive that it temporarily took analysts’ attention away from Bristol’s flagship immuno-oncology therapy Opdivo, which has suffered some setbacks. Leerink analyst Seamus Fernandez upgraded his price target from $62 to $66 following the first-quarter results, partly based on the positive Eliquis surprise.

Pointing north
But do not count Xarelto out just yet. The Compass trial, stopped early for efficacy, has shown that Xarelto can prevent major adverse cardiovascular events in patients with coronary or peripheral artery disease (Xarelto scores again in huge heart trial, February 9, 2017).

The data from Compass, now expected to read out at the European Society of Cardiology meeting in late August, could help Bayer and J&J achieve a major expansion from current indications: stroke prevention in atrial fibrillation patients and deep vein thrombosis prophylaxis in patients undergoing knee or hip replacement surgery. Past attempts to expand indications, such as to patients with acute coronary syndrome or the medically ill, have failed.
Bayer disclosed little about the results in its call, and would not even suggest when the Compass data would be revealed. But with 15.5 million Americans estimated to have coronary heart disease and 8.5 with peripheral artery disease, Compass represents a significant opportunity.

For their part, Bristol executives seem nonplussed about the Compass data – probably because it will not affect prescribing patterns in the key atrial fibrillation population. It does not appear that a similar trial of Eliquis has been initiated.
Of course, with trends in the atrial fibrillation market what they are, Bristol may be judging that the cost of an expensive new trial – Compass enrolled 27,000 – might not offset the market share gains.

With a superiority edge over warfarin on serious bleeding incidents – something Xarelto was unable to prove – Eliquis has a better hand to play in negotiating with payers looking to secure outcomes-related contracts. Fewer bleeding incidents means fewer patients in the hospital, meaning fewer costly complications related to use of Eliquis; this could help explain the payer pressure on Xarelto.
Bayer and J&J might have a chance to grow Xarelto sales based on Compass, which is fortunate because the beginning of 2017 has shown how much fight Eliquis is giving it in the established market.