–But the overall market for the new oral anticoagulants continues to expand.

The new oral anticoagulant (NOAC) market is growing larger and is becoming increasingly competitive. The latest market data shows that apixaban (Eliquis, Pfizer and BristolMyers Squibb) is challenging the established leader in the field, rivaroxaban (Xarelto, Johnson & Johnson).

According to recent data from IMS Health Incorporated, Xarelto now has 46.5% of the NOAC market, compared with a 42.5% share for Eliquis. This represents a decline in share for Xarelto from a peak of about 60% of the market, while Eliquis has enjoyed continuous growth in its market share over the last few years. By contrast, dabigatran (Pradaxa, Boehringer-Ingelheim) has 10.5% of the market and edoxaban (Savaysa, Daiichi Sankyo) a miniscule 0.5% of the market.

The overall NOAC market continues to grow, since older anticoagulants, most notably warfarin, continue to dominate the market, accounting for nearly two-thirds of prescriptions. The NOACs have been slowly gaining ground on warfarin, which is much less expensive but requires frequent monitoring and has multiple interactions with other drugs and foods.

Eliquis has caught up to Xarelto despite the fact that it was approved after Xarelto and despite the fact that it is taken twice-a-day, compared with Xarelto’s once-daily dosage. But its more convenient dosing may also be the key to Xarelto’s relative weakness, since many cardiologists and other specialists now feel that the drug does not provide complete 24 hour anticoagulation. Xarelto has also been plagued over the past year by reports about problems concerning the integrity of ROCKET-AF, the main trial supporting the drug’s use for stroke prevention. More recently, however, the FDA and the EMA have separately reaffirmed the validity of the trial.

“The bottom line for me is that safety data for apixaban are compelling and there are no issues with trial design or other problems,” said Ethan Weiss, a cardiologist at UCSF, perhaps explaining the shift in favor of Eliquis over Xarelto.

Wells Fargo analyst Lawrence Biegelsen predicts that Xarelto sales could exceed $600 million in the third quarter.

To date there have been no large randomized trials comparing the different NOACs. Recently the Patient-Centered Outcomes Research Institute (PCORI) agreed to fund a study comparing rivaroxaban, apixaban and warfarin.

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Larry Husten was the editor of TheHeart.Org from its inception in 1999 until December 2008. Before that he was a freelance medical journalist who wrote for The Lancet, The New York Times, Discover, and a large number of other medical and computer publications. In 1994-1995 he was a Knight Science Journalism Fellow at MIT. He received a PHD in English from the State University of New York at Buffalo and drove a taxicab in New York City before embarking on a career in medical journalism.

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1 Comment

  1. Interesting data. I switched my new NOAC prescriptions to eliquis to xarelto a few years ago for most new patients because I thought the ARISTOTLE data demonstrated that eliquis was superior to warfarin for stroke prevention and less likely to have bleeding complications whereas Xarelto was, at best noninferior. The only factor preventing me from having all patients on Eliquis has been less favorable insurance coverage of Eliquis compared to Xarelto or Pradaxa. I rapidly moved away from Pradaxa due to GI side effects and only prescribe it now for patients who feel convinced that they need an antidote.

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