Comments on: Catching Cold: Merck Sneezes Over Singulair Scrips

By: Zyflo?

Zyflo? — Sun, 15 Jun 2008 14:27:30 +0000

I’m curious if the same sentiments apply for the other leukotriene inhibitor Zyflo? I’ve heard that its actually better than Singulair, but not prescribed much since its not promoted and Singulair has the Merck machine behind it. Sam or M Helm or anyone else, do you know much about Zyflo?

By: Sam

Sam — Thu, 12 Jun 2008 15:11:35 +0000

M Helm,MD
In my area where I am a pharmacist, I have found that the prescribing
of Singulair has not decreased. In fact all three strengths have had an
increase in the number of prescriptions.

I have also seen an increase in the number of TV ads for this drug.
A study showed that when a lay-person request a drug due to DTC
40% of the physicians will write for it. PHARMA now spends $5 Billion
from $3.2 Billion in 2003.

Maybe not all physicians are getting the information you noted in your
e mail.

By: M Helm, MD

M Helm, MD — Tue, 10 Jun 2008 00:02:33 +0000

Ed, there are a few more (clinical) reasons the montelukast forecast is not so bright.

The most recent NHLBI asthma treatment guidelines were considerably less favorable toward montelukast as an asthma controller. The data behind the recommendations has caused some debate over the role of montelukast as an asthma controller.

As an allergy agent, Merck’s own data has shown that it is not significantly better than loratadine. In fact, in a Merck clinical trial, pseudoephedrine matched or outperformed Singulair for nasal congestion symptoms in patients with allergy. The cost of Singulair is more than $100 per month, compared to less than $10 per month for over-the-counter loratadine. This is a hard differential to ignore.

There is also I believe, a growing feeling among many physicians that the benefits of montelukast have been over-sold to physicians and patients alike. I know quite a few allergists and pedicatricians who feel that montelukast is over-prescribed.

There are certainly some useful niches for montelukast. In combination with other agents for patients with severe asthma or allergies montelukast is a helpful product for many. For some patients, it truly is “just what the doctor ordered.” Nevertheless, I predict that self-insured plans will increasingly look for ways to “manage” the use of montelukast, if they can convince their PBMs to take the rebate/revenue hit.