Clarinex, Nexium, Nexperdal?

Clarinex, Nexium, Nexperdal?

J&J is stealing a play from AstraZeneca and Schering-Plough. AZ couldn’t come up with a worthy successor to Prilosec, so when the drug went off patent the company introduced the infamous Nexium, which is the substance the body turns Prilosec into. Basically you get Nexium when you swallow Prilosec, yet Nexium managed to become a multibillion product. Clarinex is just a tiny tweak on Claritin, introduced when Claritin’s patent expired.

Now J&J is faced with the expiration of its blockbuster for schizophrenia, Risperdal. When a patient takes Risperdal the body converts it to paliperidone. So just like AZ, J&J is going to market paliperidone as the next thing. J&J claims paliperidone is better than Risperdal, but that’s doubtful. From the Wall Street Journal:

The research backing J&J’s claims for paliperidone seems a little thin. Clinical tests, involving 1600 patients, pitted it against a sugar pill, not Risperdal or other antipsychotic drugs…

“They can’t claim its better than risperidone [Risperdal’s generic name] because they didn’t do the comparison,” said [Duke psychiatry professor] P. Murali Doraiswamy.

Basically, J&J is proving that paliperidone is better than nothing. That’s not a very high standard.

Meanwhile doctors, health plans, and patients haven’t set a very high standard either. Doctors continue to accept Nexium samples and prescribe the drug, most payers still have it on formulary, and patients continue to insist on the purple pill. Time to wise up!

J&J hasn’t picked a brand name for paliperidone yet. Here are a few suggestions:

  • Nexperdal
  • Ripofferdal
  • Desperal
September 29, 2006

4 thoughts on “Clarinex, Nexium, Nexperdal?”

  1. You are wrong – several times over.

    1.The active ingredient in Losec is meprazole. This is a chiral molecule with two isomers. Often when this happens, one isomer is inactive – then the other is twice as effective as the racemate (that’s the mixture) or even harmful (then it’s good news to remove it and make the product the good, active part only). Obviously you do not know this. Check your facts before sounding off!

    2. There is no rule which says that a single isomer compound is converted into the racemate in the body – though it MIGHT happen. Check your facts!

    3.The J&J issue is quite different because the new compound is “slightly” different and that can be seen from the molecular formula. The relevant molecule is not a chiral and the “old product” is not a racemate and the new product is not presented as a single isomer. Check your facts!

    4. I can see no reason why drug manufacturers should not try and extend their franchise – that’s what Ford, Coke, McDonalds, Nike, Bloomingdale’s and organic food sellers do. Check your facts!

    5. Maybe, in the case of a patented protected molecule that is considered unreasonable – at least by you! But, if it is really unreasonable then there are grounds for action. Believe me, if a generic drug manufacturer wants to challenge A/Z or J&J it will and the courts tend to favour the generic manufacturer (ask Pfizer or GSK!). Check your facts!

    So your screeching (that’s the noise monkeys make) is immaterial as well as wrong. If J&J is bending the rules, they will fail. If they are playing by the rules (let the regulators and the courts decide) what makes you think you are the ultimate arbiter?

    Are you really so special – or competent to decide on matters that you don’t understand?

    Why don’t you stick to things you really know about? It would be interesting to know if there are any because the evidence to date is limited.

    Keep smiling!

  2. ALAN, (aka A Lonely Advocate of Nexium):

    Thanks for the chemistry lesson. I should have done a better job on that aspect of the post. But you overreach by implying single isomer drugs are twice as effective. The improvements, if any, are usually modest.

    The reason Nexium, Clarinex, paliperidone and others of their ilk are developed and marketed is because their makers have failed to innovate with new molecules. These drugs aren’t much better than their predecessors, if they’re better at all. They are, however much better commercially because they can be priced as though they are innovative. I don’t blame the drug makers for taking this route. After all, payers have been foolish enough to pay for Nexium, doctors gullible enough to prescribe it, and patients naive enough to demand it.

    Meanwhile, the Nexiums, Clarinexes and paliperidones of the world are not the equivalent of consumer product company line extensions. When Coke added Cherry Coke it wasn’t because the price of Coke dropped by 90% and everyone began making it. Coke and your other examples are not paid for by third-parties. They’re also not prescribed by intermediaries.

    Finally, the idea that the courts favor generic companies is just not true, even if it feels that way for big pharma sometimes. But that’s a subject for a different post.

  3. “The active ingredient in Losec is meprazole. … Check your facts before sounding off!”

    That would be “omeprazole”. Check your facts indeed.

    “The reason Nexium, Clarinex, paliperidone and others of their ilk are developed and marketed is because their makers have failed to innovate with new molecules.”

    With central nervous system drugs, it is foolish to assume that a small chemical change is meaningless. Such changes often make a big difference in tolerability for some people. This is especially important for neuroleptics like paliperidone, where a frequent side effect is idiosyncratic permanent brain damage. Until a high-efficacy cure for schizophrenia comes along, its victims will always be grateful for another drug to try.

    I would also suggest that you peruse the chemical structures of the tricyclic antidepressants. They’re a whole zoo of variations on a theme, yet they have a wide range of effects, therapeutic and otherwise. For example, some of them are highly sedating, while others are moderately stimulating.

  4. I agree with you on the desirability of drugs that are slight variations on a theme, especially for psychiatric and neurological indications. I think the drug companies would do well for themselves in the long term if they presented these new products as better for some people (even if those people are hard to identify) rather than better across the board.

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