The antihypertensive market in the UK is notoriously competitive and product differentiation is difficult. Aprovel (irbesartan), co-marketed by sanofi-aventis and Bristol-Myers Squibb is one of seven ARBs on the market. Aprovel had found itself niched into the diabetes market, because of one aspect of its licence indication. Although Aprovel’s main licence is for essential hypertension, it has a well established impact on a relatively unknown element of the slide into renal failure, microalbuminuria (MAU), defined as a small amount of protein in the urine. Initial research confirmed that many of the pivotal KOLs in hypertension did not appreciate the importance of MAU in vascular disease; neither was there strong evidence supporting the earlier use of ACE inhibitors/ARBs in patients with MAU. In fact, Aprovel had compelling data to support its use in early stage renal disease in patients with type 2 diabetes and hypertension, with studies proving its ability to regress MAU.

It was clear that, if MAU testing was more commonplace, clinicians would be better positioned to identify high risk patients who would benefit from aggressive treatment, ensuring earlier prescribing of ARBs in patients with hypertension and risk factors. The strategy was thus to link Aprovel intrinsically with MAU, and MAU with hypertension.

WHAT WE DID:

A map of key influencers in the fields of cardiology, nephrology, diabetology and primary care was developed. In total, 22 KOLs representing numerous professional and policy groups, including the National Clinical Director for Heart Disease, participated in the programme endorsing the need to screen MAU in hypertension and the earlier use of ACE inhibitors/ARBs in these patients. A core body of top-tier opinion leaders from across these disciplines was established and met twice in 2005, resulting in the development and endorsement of a treatment algorithm, which was endorsed by the world’s leading expert in MAU. In addition, members published 13 articles on MAU in primary and secondary care press. A major national meeting for secondary care physicians was held and was awarded 10 CPD points. The meeting was captured in an interactive format, so that delegates could run similar meetings with their colleagues. The target had been to engage 1,000 cardiologists post event but the phenomenal success of the programme, and the curiosity around MAU as a risk marker, resulted in over 3,000 specialists being exposed to the Aprovel efficacy and protection messages within 12 months - 300% above target. We also secured a highly coveted satellite slot at the British Cardiac Society Annual Conference.

THE RESULTS:

• 96% of cardiologists now believe that regression of MAU is an important goal – an increase of 82% in 12 months
• 87% of cardiologists now routinely test their hypertensive patients for the presence of MAU (8% 12 months previously)
• MAU included in latest Joint British Societies 2 (JBS2) Guidelines for the Prevention of Cardiovascular Risk in Clinical Practice
• Market research in January 2006 showed that MAU testing in hypertensive patients increased from 8% to 87% amongst cardiologists