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As promised, Novartis' Entresto is a 'slow burner'

Inverts typical sales pattern with faster uptake of the drug in Europe than in the US

NovartisNovartis' much-lauded new heart failure drug Entresto has sold more in Europe than the US since launch, turning the usual sales pattern on its head.

Widely tipped to become a multi-billion dollar brand, Entresto (valsartan and sacubitril) brought in just $17m in sales in the first quarter, with greater prescribing momentum in EU markets thanks largely to prescribing hurdles introduced by health insurers in the US.

"We cautioned that uptake, particularly in the US, would be very slow at the beginning because access would be blocked," said Novartis' pharma chief David Epstein on the firm's first-quarter results call.

However, "we remain confident that the sales of this product would be in the range of $5bn in reduced ejection heart failure", its first approved indication, he added.

Despite stellar efficacy data from the PARADIGM trial, managed care plans in the US have put hurdles in place - including a requirement for prior authorisation - that have made physicians reluctant to write Entresto prescriptions, particularly for patients who are stable on current therapies.

Based on its initial experiences in the US, Novartis has also focused its marketing efforts in Europe on heart failure patients with symptoms - i.e. those who are not stable - and has found that doctors are more likely to prescribe in these cases.

Novartis is predicting sales will start to accelerate in the second half of this year and drive the product to around $200m in sales for 2016 as a whole. Additional momentum could come from new indications - including preserved ejection heart failure (assuming the ongoing PARAGON trial is positive) and post-acute myocardial infarction.

While Entresto is growing slowly, Novartis' other main product launch - Cosentyx (secukinumab) for psoriasis, ankylosing spondylitis and psoriatic arthritis - is off to a good start with quarterly sales of $176m, up from $22m in the same period of 2015.

Epstein pointed to particularly strong take-up in Germany. Having already overtaken Johnson & Johnson's rival psoriasis drug Stelara (ustekinumab), Cosentyx is on course to topple AbbVie's Humira (adalimumab) as the number one biologic brand in the German market, he added.

Interestingly, he noted that with increased resistance to the use of high-priced new biologic drugs in the US - which often takes the form of 'step-edits' in which patients must exhaust other treatment options beforehand - the situation in Europe is freer.

"In Europe, those step-edits do not exist, which means a patient can move immediately from oral therapy to Cosentyx at the first biologic therapy," he said.

Cosentyx was however a high point in a quarter undermined by generic competition to Novartis' cancer drug Glivec/Gleevec (imatinib) - with sales down 22% to $835m - and underperformance by eye health unit Alcon.

Net sales fell 3% to $11.6bn in the quarter and Novartis reported a 12% reduction in operating income to $2.5bn.

Article by
Phil Taylor

22nd April 2016

From: Sales

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