GROWING little by little

PERQ/HCI's Journal Ad Review(TM) (JAR) reported a 3 percent gain in ad spending for medical/surgical journals during 2003, an amount that was only slightly above the I percent increase observed for the full year 2002. The anemic performance within the medical/surgical sector is largely due to the lack of major new products which appeal to a broad-based physician population. For example, in 2003 only two products (and one pre-launch campaign) advertised in medical/surgical journals at a level sufficient to move them into the top 25 product list. This number is below both 2002 (four new products) and 2001 (five new products).

When measured in the number of ad pages, the increase (2003 vs. 2002) was only 1 percent. The actual number of medical/surgical ad pages reported in JAR in 2003 was 99,989 versus 99,458 in 2002. A look at the top five medical/surgical journals (at the top of this page) indicates that only two had an increase in ad pages during 2003. As a group, the number of ad pages for all five fell by 5 percent while their share of all medical/surgical ad pages dropped from 14.5 percent in 2002 to 13.8 percent in 2003.

The following is a review of the companies, products and therapeutic categories that make up the top 25 lists.

The top advertiser

With a 13.2 percent share of all ad expenditures in medical/surgical journals, Pfizer was by far the number one advertiser in 2003. This high share is due to the fact that during 2003, Pfizer advertised more than 20 products, eight of which were in the 25 most heavily advertised product list. GlaxoSmithKline, unchanged in the number two spot, had a 5.3 percent share while Forest moved up from 4th to 3rd, due almost entirely to higher ad spending for Lexapro. AstraZeneca and Novartis each advanced two spots to 4th and 5th, respectively. In addition to increasing ad outlays for Nexium, AstraZeneca also increased the budget for the antipsychotic Seroquel and initiated promotion for Crestor. Novartis' gain of 6 percent was spread across a number of products.

A 45 percent budget cut dropped Wyeth from 3rd to 6th, while Merck advanced from 9th to 7th, even though ad spending was reduced by 11 percent. New to 2003's top 25 is Eli Lilly, which jumped from 30th to 8th, following the introduction of Strattera for Attention Deficit Hyperactivity Disorder (ADHD), higher ad outlays for Zyprexa, and pre-launch advertising for Cymbalta. Abbott edged up one spot to 9th while Avenus fell from 5th to 10th after cutting expenditures by 54 percent. This decline is clue largely to lower ad budgets for AIIegra, Amaryl and Lovenox.

Others new entrants included the Merck/Schering-Plough joint venture which markets Zetia, up from 79th to 13th, McNeil Consumer & Specialty, up from 40th to 15th due to heavy ad outlays for Tylenol and the muscle relaxant Flexeril, and the Bristol-Myers Squibb and Otsuka partnership which climbed from 84th to 17th. Also entering the top 25 is Bristol Myers-Squibb, up from 53rd to 21 st, due to considerable ad spending for the oral diabetes products Glucovance and Metaglip, for the HIV-reverse transeriptase inhibitor, Videx EC and for the antiviral, Reyataz. Endo Pharmaceuticals moved up from 41st to 22nd due to higher ad expenditures for the topical anesthetic Lidoderm.

The most advertised brand

For the second year in a row, Lexapro maintained its position as the most heavily promoted therapeutic product with a 4.4 percent share of ad spending in medical/surgical journals. As Forest Pharmaceuticals increased spending of this relatively new SSRI by 73 percent, ad expenditures for its earlier market entree, Cclcxa, were eliminated during 2003.

The next three products, Norvasc, Relpax and Lipitor, are all manufactured by Pfizer and together represent 5 percent of 2003 medical/surgical ad expenditures. Relpax, one of 2003's new entries is an anti-migraine agent that is a competitor to products such as Imitrex, Maxalt and Zomig. Meanwhile, the number-one selling drug in the world, the cholesterol-lowering Lipitor, increased ad outlays by 49 percent as competition heated up with the introduction of AstraZeneca's Crestor and with the relatively new entry Zetia, which is jointly marketed by Merck and Schering-Plough, and which ranked 5th in journal ad spending.

A 54 percent boost in ad outlays advanced Pfizer's Neurontin from 23rd to 6th, while Ambien and Avandamet, both new to the lop 25, ranked 7Ih and 8th, respectively. After cutting expenditures by 21 percent in 2002, Nexium's ad budget increased by 23 percent to move the AstraZeneca's brand into 9th place. The company's older proton pump inhibitor, Prilosec, is now available generically and is also being marketed as an OTC by Procter & Gamble. Ability, an antipsychotic introduced early in 2003, took 10th place. This is the only product currently being advertised by the Bristol-Myers Squibb and Otsuka partnership.

Pfizer's Xanax XR, a new extended-release benzodiazepine, which is being advertised via a 4-page spread, ranked 19th. Interestingly, Lilly has been running a series of ads dealing with depression since june 2003, in anticipation of the introduction of Cymbalta, a new product that will compete in the SSRI/SNRI therapeutic category. This pro-launch ad effort ranked 22nd.

Other products new to the lop 25 lists include Plavix, up from 28th to 21st, Celebrex, which advanced from 37th to 24th, and Vfend, up from 68th to 25th on a 107 percent boost in spending. Of note is the fact that these last two entries, as well as six others in the top 25, are manufactured by Pfizer.

The top therapeutic category

Higher ad spending for Lexapro, Paxil CR and Zoloft, coupled with a pre-launch advertising campaign for Cymbalta, ensured that SSRI/SNRI's remained the number one therapeutic category with a 7.4 percent share. Cytostatic drugs-other moved up one spot to 2nd, while antipsychotics-other advanced from 10th to 3rd, following a 62 percent boost in spending due largely to Abilify, Geodon, Seroquel and Zyprexa.

With the exception of Nexium, all Rx proton pump inhibitors reduced spending during 2003, thereby dropping the category two places to 4th. Seizure disorders, driven largely by higher spending for Neurontin, climbed from 11th to 5th, ethical drugs miscellaneous-other edged up two spots to 6th and cholesterol reducers-Rx statins slipped from 4th to 7th following budget cuts on Lcscol XL and Zocor.

The first of six new drug classes to move into the top 25 was the anti-migraine category, up from 43rd to 8th due to the introduction of Relpax. Cox-2 inhibitors dropped from 5th to 9th as ad expenditures were reduced for Bextra and Vioxx, while calcium blockers slipped one spot to 10th. Other therapeutic classes new to the 2003 top group include diabetes combinations, up from 104th to 14th as GlaxoSmithKline and Bristol-Myers Squibb spent heavily on their respective products, and cholesterol reducers-Rx others, up from 110th to 17th following higher ad expenditures for Zetia.

Also moving up sharply during 2003 was the Interferon drug class, up from 37th to 21st due to Roche's Pegasys, the biological response modifier category, up from 46th to 22nd following strong support for Abbott's new entry, Humira, and Alzhcimer-type dementia agents, which climbed from 32nd to 25th as Janssen Pharmaceutica spent heavily on Reminyl.

Drug classes dropping out of the top 25 include antihistaminescaps/tabs as ad spending was cut for both Allegra and Clarinex, anti-platelet agents, and oral diabetes preparations, due to acrossthe-board budget cuts on most major products. Also missing from the 2003 list are anticoagulants, injectable due to lower ad expenditures for Lovenox, oral contraceptives, estrogen w/progestogens, and contraceptive preps-other, following reduced ad spending for Ortho Evra.