Anti-Anginal Medication: Ranexa™ Trends in Use

A Survey of One Hundred Two Cardiologists and Primary Care Physicians

July 2007

Study Description

Study Objectives

To clarify current usage patterns and potential for the CVTX’s anti-anginal medication Ranexa™ (ranolazine).  A survey of cardiologists and primary care physicians was conducted to: 

• Quantify current and future applications of Ranexa™ and determine market shares among therapeutics currently used to treat chronic angina pectoris.
• Understand drivers of physician prescribing practices, especially with regard to facilitators and barriers to use of Ranexa™ (clinical data, treatment guidelines, cost, insurance coverage, others).
• Determine the potential impact of a large-cap pharmaceutical partner on Ranexa™ prescribing volumes among primary care physicians and cardiologists.
• Determine awareness and impact on prescription patterns, if any, of the MERLIN-TIMI 36 Randomized Trial on Ranexa™ (data published in the Journal of the American Medical Association in April 2007).

Companies Mentioned in This Report

inclusion criteria and Respondent demographics

Key Findings

Ranexa™ is prescribed for 12% of chronic angina patients; growth expected: Cardiologists and PCPs prescribe Ranexa™ for 10% and 15% of their chronic stable angina patients, respectively.  Respondents prescribe Ranexa™ 1st-line for 8% of patients and 2nd-line or later for 11% of patients, on average.  In the next 12 months, cardiologists expect to prescribe Ranexa™ for 16% of 1st-line patients and 18% of 2nd-line+ patients.  PCP respondents anticipate prescribing Ranexa™ for 16% and 21% of 1st-line and 2nd-line+ patients, respectively

Untapped potential: On average, 36% of chronic angina patients have failed at least one line of therapy.  Among this subset of patients, respondents indicate an average of 46% are potential candidates for Ranexa™.  Only 19% of the same subset are currently taking Ranexa™.

QTc prolongation risk may not be a big issue: Among the 95 respondents who are currently prescribing Ranexa™, 76% state that the risk of QTc prolongation has affected their Ranexa™ prescribing only “Slightly” (50%) or “Not at all” (26%).

Cost a significant barrier: Patients have chosen not to take Ranexa™ due to high cost or co-payments in 26% of cases when respondents have prescribed it.  This percentage is slightly higher among PCPs versus cardiologists (29% and 24%, respectively)

Likely positive impact of partnering with large pharma: About a third of respondents indicate increased availability of samples, increased visits from Ranexa™ sales representatives, and inclusion of Ranexa™ in angina treatment guidelines would likely increase their prescribing by 10% to less than 25%.

Significant percentages of PCPs indicate their prescribing would increase by more than 50% given Ranexa™ were able to achieve either an increase in published data, inclusion in treatment guidelines, or improved formulary status (29%, 33%, and 37% of PCPs, respectively) .  Most cardiologists indicate prescribing would increase by less than 25% given any of the scenarios mentioned.

Some off-label use: While most patients treated with Ranexa™ are receiving the drug for its approved use in chronic angina (79% of patients, on average), a significant percentage are taking Ranexa for other indications – 10% for coronary artery disease, and another 6% of patients for acute angina.  37% of respondents have prescribed Ranexa™ for use in coronary artery disease, 16% for acute angina and 11% also for heart failure.

Overall positive impression: On a scale of 1 to 5, with 5 being “very positive,” physicians rated their overall impression of Ranexa at 4.0, or “positive.”  Overall safety profile and efficacy for uses other than angina were both rated neutral to positive (3.7 and 3.5, respectively).  Cardiologists and PCPs rated Ranexa™ attributes similarly.  The lowest ratings were for cost and level of reimbursement (2.7 and 2.9, respectively)

MERLIN failure not all negative: 64% of respondents indicate their Ranexa™ prescribing has remained the same (if they were previously aware of the MERLIN-TIMI 36 trial) or will remain the same based on the data published in April.  32% suggest their prescribing has increased or will increase as a result of this information.

detailed respondent information

S3.              Approximately how many years have you been in practice post-residency?

S4.              Approximately what percentage of your professional time is spent in clinical practice?

S5.              Please select the setting which best describes where you spend most of your time in clinical practice.

Note: shading indicates greatest percentage of respondents within a given category

S6.              Please estimate the number patients you currently manage who have been diagnosed with chronic angina.

S7.              Please estimate the percentage of your <insert S6 response> chronic angina patients who are currently receiving medication for angina.

S8.              Approximately how many prescriptions per month do you write on average for the management of chronic angina?

SECTION ONE: CURRENT PRESCRIBING PRACTICES FOR CHRONIC STABLE ANGINA

Q1.              What percentage of your diagnosed chronic angina pectoris patients is currently taking Ranexa™?

Q2.              What percentage of your diagnosed chronic angina pectoris patients is currently taking each of the following classes of medications for 1st and 2nd-line+ management of angina?

Summary Table: All respondents and specialties; % of patients by line and drug class

Agents listed in survey – ACE Inhibitors: ramipril (Altace®), benazepril (Lotensin®), captopril (Capoten®), enalapril (Vasotec®), lisinopril (Prinivil®), others; Beta Blockers: atenolol (Tenormin®), carvedilol (Coreg®), metoprolol (Lopressor® or Toprol XL®), others; Calcium Channel Blockers (CCBs): amlodipine (Norvasc®), diltiazem (Cardizem® or Tiazac®), verapamil (Calan® SR), felodipine (Plendil®), others; Other anti-anginal: ranolazine (Ranexa™); Glycoprotein IIb/IIIa Inhibitors: clopidogrel (Plavix®), others; Statins: simvastatin (Zocor®), atorvastatin (Lipitor®), pravastatin (Pravachol®), lovastatin (Advicor®), fluvastatin (Lescol®); Beta Blocker/CCB fixed combination: atorvastatin/amlodipine (Caduet®); ACE Inhibitor/CCB fixed combination: benazepril/amlodipine (Lotrel®)

Note: totals add to more than 100% due to combination therapy.

Q2a.              What percentage of your diagnosed chronic angina pectoris patients is currently taking each of the following classes of medications for 1st-line management of angina?

All Respondents – % of 1st-line patients taking angina medications by drug class

Cardiologists – % of 1st-line patients taking angina medications by drug class

PCPs – % of 1st-line patients taking angina medications by drug class

Q2b.              What percentage of your diagnosed chronic angina pectoris patients is currently taking each of the following classes of medications for 2nd-line+ management of angina?

All Respondents – % of 2nd-line+ patients taking angina medications by drug class

Cardiologists – % of 2nd-line+ patients taking angina medications by drug class

PCPs – % of 2nd-line+ patients taking angina medications by drug class

Q3.              Among your patients receiving Ranexa™, what percentage is also taking each of the following medications or classes of medications for management of angina?
(Answered if respondent currently prescribes Ranexa™, indicated by Q1 greater than 0%)

All Respondents – % Ranexa™-treated patients taking concomitant angina medications by drug class

Cardiology – % of Ranexa™-treated patients taking concomitant angina medications by drug class