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Heartburn ads treat the pain of drug firms

BY BRUCE JAPSEN
Chicago Tribune

CHICAGO - (KRT) - Mar. 09, 2005 - When government regulators close the door on a class of prescription drugs, it doesn't take long for the $135 billion U.S. drug industry to find another portal of opportunity. Sensing the possibility of such a government move, the makers of expensive heartburn drugs have launched an assertive advertising campaign pegged to the fall from grace of popular arthritis painkillers Vioxx, Celebrex and Bextra.

When the so-called Cox-2 drugs were reported to increase the risk of heart attack and stroke, millions of pain sufferers have begun switching to older arthritis remedies that can put some people at risk for stomach irritation. In response, some drugmakers, including the Lake Forest, Ill.-based maker of Prevacid, are encouraging people who have switched to ibuprofen, naproxen or aspirin to follow it up with one of its $4 heartburn pills - a $1,500-a-year proposition when there are many less-expensive alternatives.

Prevacid-maker TAP Pharmaceutical Products Inc. and the London-based maker of Nexium in recent weeks have taken out ads in U.S. newspapers warning switchers they may be at risk for stomach problems if they have turned away from Vioxx and other drugs in favor of older arthritis remedies.

But some doctors, insurers and consumer groups say those who take the drugs should be skeptical.

"This is marketing, not science," Dr. Allan Korn, chief medical officer for the Chicago-based Blue Cross and Blue Shield Association, a trade group representing some of the nation's largest health plans, says of the ad blitz for Nexium and Prevacid. "The vast majority of patients who take pain pills have no stomach problems."

Cox-2s became popular when they were launched in the late 1990s because they were believed to be safer for the stomach lining.

Some doctors routinely switched patients away from non-steroidal anti-inflammatory medicines such as ibuprofen and naproxen.

However, the promise of Cox-2s' greater safety for the stomach remained largely unproven, a finding reiterated by the same Food and Drug Administration advisory panel that warned of safety risks for the Cox-2s last month.

In addition, people with stomach problems have plenty of cheaper alternatives that cost $1 or less a day, including over-the-counter Prilosec, a therapeutically equivalent heartburn drug to Nexium and Prevacid that costs less than 80 cents a pill.

Patients swayed by the ads could spend an extra $1,500 or more a year if they end up taking Nexium or Prevacid daily and have no drug coverage, doctors and insurers say.

"(Consumers) have to figure if they need that level of stomach protection because there are different approaches to protecting the stomach and they range (in price) from $1 a day to more than $4 a day," said Dr. Elbert Huang, an internist at University of Chicago Hospitals. "The Prevacids and the Nexiums are the most expensive options. There are many options for people."

Unless patients have stomach bleeding or severe gastrointestinal problems such as ulcers, doctors say, they probably do not need Nexium or Prevacid and they should first try one of the myriad generic or over-the-counter remedies that could be effective and cheaper.

For example, Huang said Extra Strength Tylenol is a first-line treatment for osteoarthritis and is generally not perceived as harmful to the stomach. He also cited generic misoprostol, which typically costs $1 a pill or less, and is often prescribed for patients who take anti-inflammatory drugs regularly.

Still, Prevacid maker TAP and Nexium maker AstraZeneca PLC say their drugs are superior at treating gastroesophageal reflux disease, commonly known as GERD, as well as more serious acid-related disorders.

In a full-page ad appearing recently in several national and regional newspapers, TAP tells readers that the older non-steroidal anti-inflammatory drugs "can cause stomach ulcers." The ad shows a hole burning into a pink background.

"It's also been shown that Prevacid can treat them," the text says.

The ad warns readers who may have switched to an anti-inflammatory drug that such drugs can "weaken the lining" of their stomach, allowing acid to cause ulcers. "If that happens, Prevacid can help," the ad reads.

AstraZeneca has taken out its own ads and hired public relations firm Burson Marsteller to push the use of proton-pump inhibitors for acid-related disease.

In its ads AstraZeneca tells patients who have switched from Vioxx or another pain medication that they "may be at risk for stomach ulcers." "Our hope is that this piece prompts more informed patient/doctor discussions about the appropriate role stomach acid inhibition may play in reducing the chances of stomach ulcers developing among at-risk chronic NSAID users," said Cindy Callaghan, AstraZeneca's director of brand communications.

Neither AstraZeneca nor TAP would disclose how much they are spending on marketing their heartburn drugs to patients who use non-steroidal drugs. In 2003 the two companies spent more than $300 million combined on all consumer ads for the drugs, including television.

The two firms are slugging it out for third and fourth place among the nation's top-selling brand-name drugs, health information firm IMS Health said. Prevacid and Nexium each generated about $3.8 billion in U.S. sales last year.

They were topped only by the cholesterol drugs Lipitor, which had $7.7 billion in sales, and Zocor, which generated $4.6 billion in revenue.

Some doctors and insurers say Nexium is not a significant improvement over Prilosec. AstraZeneca's own head-to-head comparison shows Nexium is about 3 percent better at controlling and healing damage. Meanwhile, Chicago-based Abbott Laboratories, which owns half of TAP, touted head-to-head studies showing "Nexium offers no clinical benefit over Prevacid."

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