Messaging and relationship management

Pharma Marketing has two major limbs: messaging and relationship management.  With technology having a profound impact on marketing process, new dimensions and possibilities emerge on the pharma marketing horizon.  Consider the following graphic of pharma messaging and relationship management:

The above graphic describes the conventional messaging architecture; however, technology enables us to provide messaging penetration.

Let us imagine, a MR (Medical Representative) manages 100 doctors, and each doctor prescribes the promoted brands to 10 patients/month (it can be any number of products).  Thus, in a month the MR gets about 1000 patients who consume the promoted brands.

In reality, it will not as perfect as above.  Alternatively, there can be 80 doctors giving 60% of the business or even the classical Pareto’s rule: 80:20.  But this point is only as a caveat.

In today’s scenario, most messaging and relationship management efforts are directed to the doctor (prescriber or influencer) for pharmaceutical products. 

In the messaging arena, the MR indulges in detailing of three types:

a)      Visual aid detailing (or using some other collateral)

b)      Extempore detailing

c)      Dialogue detailing with Yes momentum.

The realities and challenges to the MR in using the face-to-face in-clinic messaging routine are many: the well-established doctor gets atleast 300 different MRs every month.  This is about 12 MRs per day (and if repeat calls by MRs are factored in, it could be more than 300 MR calls per month to the doctor). 

If each MR is given 5 minutes by the doctor, then, it works out to: 12 MRs X 5 minutes = 60 minutes per day!  Now if a doctor is seeing 50 to 100 patients per day, you can well imagine whether he can afford to provide the 60 minutes to MRs, the doctor probably will offer only 60 seconds on a routine day (elevator pitch and no more!).  It is not an exaggeration to state that it is a great challenge for a routine MR to obtain adequate time and mind-space of the doctor!!

In fact, if the doctor gives 5 minutes per MR (and he has 12 MRs visiting per day, it is 60 minutes per day), then for 25 working days, the time for MRs would become 25 hours!  It is doubtful if a doctor can afford so much time to MRs.

Pharma companies are attempting to work round this problem, these days pharma companies give their MRs only about 100 to 150 or less than 100 doctors to manage in a month, and there is emphasis on servicing, client management and repeat calls.  In the 1990s and earlier, each MR would have to call on 250 to 300 different doctors per month.

To compound the problem of a hasty doctor call made by the typical MR, is the fact that he does not normally use this limited time effectively - due to lack of application of communication skills, discouragement by doctors to apply his detailing skills, and to top it all there is an overall dip in basic work skills of MRs, in today’s pharma world.

NEW METHODS AND MARKETING MESSAGE PENETRATION

To overcome, such challenges, pharma marketers are on the earnest and constant look-out to use as many means of messaging and relationship management.  This includes in-booth or in-stall activity, sponsoring CMEs, advertising on websites, and print and e- medical journals…all to get valuable mindspace for brand messaging and relationship management.

Application of digital and other modern technologies to doctor-centric messaging and relationship management have limited scope, since doctors are hard – pressed for time.  Doctors find it difficult to balance their professional pressures, need for constant updation of knowledge and their personal lives.  Hence, application of tech enabled marketing messaging is difficult when it comes to doctors. 

One approach would be to gift a doctor a digital assistant that provides drug information (such as safety in pregnancy, drug-drug interactions etc on a portable palm top…and when a doctor checks up a drug the brand messaging can be done on the screen shot or at other points).  Nevertheless, these devices may not be patronized by the doctor constantly, since most of the patient cases are handled by his expertise and doctors may not need a digital knowledge or prompter crutch.  Young doctors may however find it a fancy for sometime atleast.

For relationship management with doctors, the time-honoured methods are appreciating and providing positive strokes, giving samples, knowledge and brand updates (through literatures, reminder cards, CDs etc), small gifts, sponsorships, and ensuring medical representation is pleasing and regular.  Such a MR call will ensure goodwill and catalyse doctors to favour the promoted brands.

All in all, it boils down to a very challenging script to implement modern digital non-MR formats of messaging and relationship management.

MODERN TECHNOLOGY CAN OPEN DOORS TO MESSAGING PENETRATION

The marvels of information technology are such that it can catalyse messaging penetration to all other stakeholders! 

Consider the following hypothetical example:

Let us say in above graphic, 1000 patients are prescribed either an anti-diabetic brand or an antihypertensive or an antibiotic.  Now most of the pharmacies are nearby/adjoining the clinic, or at the hospital where the doctor prescribes.  And when the patient presents the prescription, a software “sitting atop the billing software” collects the patient’s mobile number and email/postal address (this is entered by the pharmacist who feeds the information after obtaining permission from the patient/patient attender.  For this effort the pharmacist can be given points, which can then be converted to a gift from the pharma company). 

The information thus collected from the pharmacist, is then sent by the pharmacist through autoemail or uploading (through wifi) onto the pharma company’s server. 

Using this information, the pharma company then sends regular brand sponsored messages that motivate the patient to take care of his or her health, or health tips through sms, or dosage reminders through sms, or reminders to take the medication before food and so on. 

This patient-centric messaging activity that is technology enabled, thus takes the pharma company’s messaging activity to the next level, adding depth to the messaging format of the company.  Brand registration, brand goodwill and brand loyalty are also built through this messaging format at the patient level. 

This database can also be used for inviting patients for health related events conducted by the pharma company either by themselves or in collaboration with health NGOs.  Example, a free yoga course for diabetics or a talk on millets and sampling dishes made from millets for diabetics…the possibilities are only limited by resources and imagination!

This is not an additional marketing cost to the pharma company, it is brand building through ethical marketing messaging penetration upto the patient level.  This approach will help secure the patients who are on the company’s brands.  Further, this avenue of patient-centric messaging and relationship management will help make up for the challenges in pharma marketing to doctors.  This will earn pharma brand owners great goodwill and brand loyalty (and strengthen corporate equity too).

One can loop the doctor in above communication strategies and events.

Cross-selling opportunity:  If an antibiotic is prescribed to patient X and if this registers on the pharma company site through the pharmacy, there is an opportunity to touch base with the patient to cross-promote a safe nutritional supplement (eg., a B complex vitamin tablet or a health drink containing a pro/prebiotic to strengthen the gut, overall well-being and energy of the patient, since antibiotics do cause weakness and other side-effects.).  The database verily opens up an opportunity for cross-selling of various nutritionals or allied products (eg., a specially formulated toothpaste for diabetics (mouth is the index of the body!)), or aids (such as diabetes friendly slippers etc), or even special foods such as VCO (virgin coconut oil)!  If an antifungal is prescribed, a special antiseptic soap can be promoted!!

While mapping data of patient purchase behaviour from the pharmacy is a fool-proof approach, since the sale of a target brand has actually occurred, patient – centric communication can also be generated from the doctor, if he is persuaded to upload patient data on company website. 

Certainly, there can be more than one approach to collecting patient – centric data and then adopting brand messaging approaches.

A unique challenge in India, is the language … one must find a method to message patients in the preferred language of the patient!

The central idea of marketing is to devise methods to create, communicate and deliver value so that customers are created, retained, and the exchange process is catalysed, benefiting all stakeholders.  Marketing is also about product penetration and increasing through-put from a customer.  The soul of marketing is creating customer delight.  Patient – centric communication as described above is another foray into the ever dynamic world of creating confidence and satiety in patients.  Thus, in the above hypothetical model we see a certainly ‘doable’ patient-centric brand communication and brand bonding exercise.  It is an example of marketing message penetration, taking the brand message next level, to patients through modern technology.

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The way forward...medical videos/graphics for story telling!

Look at the science of storytelling here!

Pharmaceutical marketers are always on the look out to tell the product story in a novel and riveting way - rightly so!  The print form of visual aid, literatures, reminder cards, and supporting small gifts like pens and stationary items, seem to hold the fort forever as collaterals to the story telling done by pharma marketers.  It has been so, for many decades.  And we have this ostrich-like attitude that this method will continue to do so!  Truly, most pharma marketers have buried their heads, like the proverbial ostrich, into the sand!  While the world is surfing ahead on a digital tide, pharma marketing seems inured to the radical social changes happening through bits and bytes.  The time of a concerted change in pharma marketing through digital route has come of age!  Pharma marketing is insidiously being drawn into the spectre of digitisation, before long digital storytelling will be the way forward and the current crop of pharma marketers will lose the plot!  The way forward is digital oriented pharma marketing.  It is about making use of graphics, videos, pictures, infographics, and other digital memes to create a digital culture of pharma marketing and storytelling!

Many laymen feel 'stories or storytelling' is about untrue or exaggerated accounts!  However, please note, dear reader, in marketing parlance, a 'story' stands to the way a brand is presented through various anecdotes, facts, figures, similes, idioms, phrases, visuals, examples, collaterals, storyboard... so on ... to captivate the listeners or viewers of the story on the brand promise or benefits!!  Stories are the oldest way of knowledge transference and help in consumption of ideas/goods/services/experiences, creating new lifestyle patterns.  Apple the iconic brand is a success through word-of-mouth passage of experiences.  In fact, digital means Apple, and the rites of passage into the digital world for all is being smart, with a smart phone in hand.  Whatsapp and sms, browsing, social media and other smartphone enabled messaging are the most influential vehicles for influencing perception change. Storytelling the clinical successes of pharma products is no more ONLY through print media - digital tools are here to create immersive experiences of storytelling!

When I did field work in Mumbai recently, I saw a poster of a pharma company, in a clinic (at the patient waiting area).  It invited me/patients to register their mobile number by sending a sms to a given number.  I did the same...today in the name of the doctor (in whose clinic the poster and number was given), I get weekly health tips!  Now that is smart digital marketing - the sponsor pharma company provides a health messaging service in the name of the doctor to patients, and this is not only strengthening the doctor patient bond, it will nurture the pharma company and doctor relationship too!

Pharma marketers, now have to work on digital push and pull processes.  Digital content richness will create the change.  Let us assume, a product marketing specialist makes a 60 second video on how his brand of etoricoxib has greater affinity to COX 2, and thus reduce pro-inflammatory prostaglandins in the inflamed or damaged tissue, in a colourful and vivid manner using cutting edge graphics, and if this video is subscribed/shown on the tab by the medical representative during in-clinic or in-booth activities, there is excellent traction for the brand.  The doctor also appreciates the video based knowledge transfer.  In fact, in coming months and years, it is such skills - to help produce  infographics, graphics, short movies, memes and other digitally created material that will enhance the pharma marketer's value.

Imagine a pharma marketer creates a 10 minute video content on how a certain antibiotic reduces the in-vitro growth of pathogenic bacteria on growth media in petri-dishes, and co-relates this evocatively to a patient's journey from infectious disease to recovery from infection, the doctor who spends watching this on his smartphone or tab or through the tab being shown by the medical representative, will have greater confidence on the marketed brand showing this video!

While the digitization trend will gain strength in pharma marketing messaging to create unusually attractive stories, it will be fuelled by the fact, that quality medical representatives are hard to come by today.  The medical representatives of the 1960s and 1970s era are just not made today!  It was their traditional role of being the pharma company's messenger and relationship builder with doctors. However, today, less contact time with doctors and low quality of communication by field personnel will increase the digitization trend irreversibly.

So the firm trend to put forth pharmaceutical storytelling in a digitally eloquent manner is creating change in pharma messaging.  No one can be insulated from major trends in society, unless we are ivory tower marketing specialists!  So happy digitally inspired pharma marketing!

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Limerick:

STORYTELLING

A pharmamarketer dedicated many stories

To sell products that removed human worries

But patients needed to know

You need positive attitude - for diseases to go

In today's world, disease like to stay, for we are full of hurries!

Take a breath, slow down your pace, learn to let go things you cannot grasp...be at peace too!  You owe it to yourself.

Haiku:

SUMMER STORIES BY MRs

The sky so blue hot

Doctors smilin' and healin'

Hot work MRs do!

MRs = Medical Representatives who are the storytellers to the medical profession.

2017: Pharma marketing @ patient engagement

2017: Pharma marketing @ patient engagement

‘PwC’s Health Research Institute (HRI) found in 2016 that the majority of consumers with chronic conditions are willing to share their health data with pharma companies, including how well treatments are working and information about daily symptoms’.

Ref.: http://www.fiercepharma.com/marketing/pwc-posts-pharma-and-healthcare-industry-predictions-for-2017

Everyone is reading the tea leaves!  Demonetization in India, has shaken up the cash based economy, digital initiatives are making a lot of waves in buy-sell transactions.  The economy has doubled its digital drive and e-commerce activities.  And yes, digital is the way forward, say the tea leaves!

With digital connect proving a method to engage directly with patients of chronic lifestyle diseases, there is a big time opportunity here for:

a)     Vendors who can create digital material and engagement strategies with patients directly on behalf of pharmaceutical marketers

b)     Retailers (pharmacies) can create a digital method to engage with patients and get pharma companies to partner them

c)     Doctors can create digital methods of interacting with patients beyond their clinics and thus strengthen their patient connect

d)   Pharmaceutical companies can also launch direct patient connect initiatives to reiterate brands and their usage

The era of digital marketing is here for savvy pharma marketing professionals who are seeing and experiencing the digital trend daily thanks to the Govt. which is also exhorting the go – digital campaign.  The governmental initiatives are creating a whole new class of digital savvy consumers and significant new numbers of people are getting digital literate.

Mobile based access is the main way in which digitisation is occurring in India today.  The mobile based digital method can be employed to create patient connect programs. 

There are two major ways of influencing the sale of medicines and nutritionals:

a)     The primary method, is the medical representative based approach, where each MR calls on atleast 10 doctors/day, who influence the consumption of medicines and nutritionals

b)    The secondary method but most equally important that engage with doctors and patients without MRs:

-          digital based messaging

-          courier (mailer) marketing, and

-          advertisements in medical and nutritional based journals. 

In this regard it is interesting to recall the very market savvy and patient friendly approach launched by IAP (Indian Academy of Pediatrics), which has launched an educational TV network for patient-waiting rooms in pediatric clinics and hospitals across the country (brand advertising is permitted in their network, based on their selection of brands).  This is a fantastic avenue to connect brands with patients in the patient waiting room of pediatric centers.

There is humongous scope for digital based marketing approach, which various market operators can cue onto.

Imaginary (hypothetical) example: Imagine a retailer sells a hypothetical brand of company P: Green Morning green tea.  While raising the invoice, the pharmacist feeds the consumer’s mobile number that has whatsapp installed in it (the number is fed after obtaining the consumer’s permission). 

The software then takes over.  Through whatsapp, the back end software sends a small post.

‘Hi!  Welcome to a clean, green and healthy morning!  Your great day starts with Green Morning, boil water with a bag of Green Morning goodness dipped in it.  The polyphenol EGCG enters the water from the tea bag to offer an amazingly high antioxidant power to quench the toxic chemicals called: free radicals, in your body.  Happy healthy mornings are Green Morning dips of healthy joy’. Buy your next pack of Company P: Green Morning tea bags from Balaji Medicals!!

Imagine such cyber-engagements, reinforcing messages, sharing consumer experiences etc., through such messaging.

There can be many such digital approaches, directly or indirectly engaging with patients and healthcare consumers, and thus produce positive healthy outcomes through influential educational messages.

The digital age in pharmaceutical marketing is all set to roll as an unstoppable juggernaut in India.  The penetration of healthcare messages and brand messages of pharmaceutical and nutritional products will thus be on a large canvas.  A new age of pharma marketing is born, say the tea leaves, … thanks to demonetization and digital social trend.

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In the above graphic Venn diagram, the universe is Pharma Product Promotion, the major sets are Medical Representative (MR) based product promotion and Non – Medical Respresentative (MR) based product promotion. 

The main activities in the MR set are in-clinic activities and in-pharmacy activities.  The main activities in the non-MR set are courier activity (mailer promotion), advertisements in medical journals and digital marketing in websites, through mobile aps, whatsapp, email, banner advertisements etc.

At the intersection of these two main sets we have activities that may be carried out by MRs, or by outsourced agencies (non-MR route) (this can be done by digital format also) – and these activities are: CMEs, stall or booth activity and campaigns.

THE RIBONYL CASE STUDY

Marketing is about expecting the unexpected!  When marketers dive into creating value offerings, they confront one of the three situations:

a)      A me-too crowded market

b)      A me-too niche market

c)      A novel market

The above image from here.

Each of these situations requires a different marketing treatment! 

When there is a novel product, it entails market building effort.  The diffusion of innovation becomes a challenge.  Locating early adopters becomes the necessity.  There are after all those doctors who look to provide novelty in their practice.  One has to win the confidence of such trend setting doctors.  Providing enough clinical experience and trial data becomes the order of the day.  Such doctors are ready to risk new products in their practice, provided they buffet their decision making practice, through hard and dependable confidence building clinical evidence.  Doctors need to see beyond the jargon and obtain confidence through pertinent scientific material.  Other conservative doctors prefer to hitch onto the novel product bandwagon only after the product has shown its mettle over time. 

A niche product has a narrow spectrum of users.  The number of prospects is limited.  Hence, a niche product is focused through targeted marketing approaches.  For instance, a monoclonal antibody such as trastuzumab for Herceptin positive breast cancer patients, is a totally niche product.  Only highly qualified oncologists can recommend the use of this product to appropriate patients. 

Entering a larger crowded me-too pharma product market is a different cup of tea!  To gain even a small market share and hit breakeven is a challenge to such a product manager or mini marketing manager.  To make a mark through the me-too product, the communication mix becomes handy in providing messaging differentiation and gain mindshare of potential prescribers. 

The communication mix includes:

a)    Packaging and labelling – with some novelty (even simple 3 D printing innovation with spot UV lamination on the pack, perhaps on the brand logo, can act as an impelling point to make the prescription decision)

b)   Personnel selling by trained MRs who can create attention value through attention grabbing talking points.  A related point is unique set of in-clinic activities supported by creative collaterals, which will work to help gain mindshare

c)      Sales promotion (aka bonus offers and bundled gifts to pharmacies or dispensing doctors)

d)     Advertisements to indulge in messaging in a non-obtrusive manner, yet effectively achieving brand registration and brand recall (eg., mobile based permission sms messaging, permission email messaging, product website, banner advertisements in therapy oriented web properties, social media viral marketing approaches, strategically placed medical journal advertising, mailer advertising (enclosing simple utility items for engagement, eg., pens), “influencing the influencer through other personal influencers” mailers (eg., sending interesting appeals through mailers to wives of doctors or parents of doctors), courier mailing of samples to doctors, and patients on recommendation of doctors, patient education material mailers to consumers, phone marketing through call centres etc.

e)  Publicity through CMEs, medical journal articles and other media articles, e-articles for surrogate word-of-mouth of the focused me-too brand

It is not possible to ride only on the winds of niche products and novel products, a large market is me-too products of proven moieties.  It is better to understand this reality and penetrate the me-too marketing through awesome communication mix.

Ribonyl: the azalide antibiotic with better patient compliance

Ribonyl is the brand name of azithromycin, a macrolide antibiotic or antibacterial.  The idea was to develop messages that are differentiated and will provide a cachet to the brand.

Brand name potency: Ribonyl comes from the word ribosome (protein factories of cells).  Azithromycin acts as an antibiotic or antibacterial by disrupting or disturbing protein synthesis on the 50 S (S = Svedberg unit) ribosomal subunit of susceptible bacteria.  Azithromycin halts protein synthesis through preventing action of peptidyl transferase, this enzyme is involved in attaching appropriate amino acid to the growing polypeptide chain on the 50 S ribosomal unit.  This way azithromycin provides bacteriostatic effect, and bacterial population stops growing, WBCs find it easier to exert phagocytic activity on these weakened pathogenic bacterial colonies.  Hence, the new brand of azithromycin is named Ribonyl, which has vigorous brand name potency.  (Note: the main competitor brands of azithromycin have brand names such as Azee, Azithral, Azimax, Aziwok, Azibact, ATM and so on).

The very name Ribonyl is attractive, scientific; explaining the name itself gives some time to engage the doctor, and compellingly offers an off-beat name and prescription secrecy.

Brand positioning statement: the azalide antibiotic with better patient compliance.

Azithromycin belongs to the azalide sub-class in the chemical class of macrolide antibiotics.  By bringing out this fact the word azalide has additional attention catching potential.  It is all about riveting the mind of the potential prescriber to the brand name and registering the brand name.

The other brand positioning statement: ‘the triple benefit antibacterial’ brings out the three cardinal benefits of azithromycin:

a)      Broad spectrum of action

b)      Convenient dosing (once a day)

c)      Patient compliance

The above are placed in the three sides of triangle brand logo in visual aid and communication literature.

Talking points for Ribonyl: it is essential to build a professional story through some off-the-routine talking points.  A repertoire of talking points was built for use in appropriate printed material:

a)    Ribonyl is effective against pathogenic typical bacteria (Gram positive and Gram negative) and Atypical bacteria.  Typical bacteria are those which are easily stained through Gram staining technique.  Atypical bacteria are those that are not easily or can’t be stained through Gram staining.  Azithromycin is active against atypical bacteria such as Chlamydia trachomatis and Mycoplasma pneumoniae.  Hence, a talking point generated was Ribonyl is effective against pathogenic typical and atypical bacteria.  This not only highlighted the unique aspect of Ribonyl, it also served to register the brand among prescribers

b)  Ribonyl is not affected by beta lactamase.  The latter is an enzyme produced by resistant bacteria and renders beta lactam antibiotics (such as penicillins, cephalosporins, monobactams and penems) ineffective.  Since Ribonyl does not have a beta lactam ring, it is not broken down by beta lactamase, Ribonyl is potentially active against beta lactamase producing bacteria as monotherapy or in combination.  This point was also a cachet for Ribonyl

c)  Ribonyl concentrates on phagocytes, and is carried to infected tissues, where it achieves manifold higher concentration compared to plasma

d)     Ribonyl has short duration of therapy, high compliance (due to once-a-day therapy, in normal cases) and is cost effective.

The above four main talking points were used for brand building communication in various printed material and while presenting Ribonyl to potential doctors.

The foundation of uniqueness in Ribonyl branding and presentation has provided robustness for its success journey.

In pharma marketing, brands form a preferred approach for gaining business.  By making novel presentations, marketers can create the unexpected and gain mindshare of potential prescribers.

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NUB OF THE MATTER

All marketers are confronting daily challenges of slicing through the market.  Most succeed partially, and a handful are declared winner marketers.  How do these winners get made?

The starting point for a winner formula in marketing is KNOWLEDGE.  To know is to win!  The knowledge starting point should be as granular (or even molecular) as it can get.  Swimming through the detailed knowledge throws up insights and ideas.  These get translated into decisions, followed by action plans and then execution.  The output decides if it was a winner approach or a mediocre one.

Is there a strategy for knowledge mining?

Knowledge (practical and theoretical) should arise from the ‘nub of the matter’.  You can call this as the ‘nub-of-the-matter approach to knowledge creation and understanding’.  In the case of developing medicinal molecules, it is normally target molecule centric R and D strategy.  Hence, to develop a knowledge that aids training and marketing, it is judicious to begin with the target molecule and develop knowledge in a nutshell in that vein.  Thus, knowing more about the target molecule responsible for the medicine’s development becomes the “nub of the matter” for developing pharma marketing strategy.

Consider the following example:

Dipeptidyl peptidase 4 enzyme (DPP4): Like all enzymes - this enzyme too is a biocatalyst, and belongs to the family of dipeptidyl peptidase enzymes (EC 3.4.14 classification).  There are many such enzymes in this family – such as, DPP3, DPP6, DPP7, DPP8, DPP 9 etc.  DPP4 is also known as CD26. 

DPP4 AND CANCER:

DPP4 has a wide ranging role in cell metabolism.  DPP4 enzyme can bind with many molecules (proline or alanine containing peptides) like growth factors and neuropeptides.  It is popular among cell biologists as an enzyme, which has association with cancer!  DPP4 enzyme levels are increased in certain cancers and reduced in certain other types of cancers.  DPP4 is marker molecule for various cancerous tumors!

DPP4 AND FIBROSIS:

Fibrosis is development of hard connective fibrous tissue in organs.  Eg., liver fibrosis.  DPP4 has been implicated in fibrosis of various organs (eg., liver and kidney).

DPP4 AND GLUCOSE METABOLISM 

DPP4 is involved in glucose metabolism.  DPP4 degrades or breaksdown molecules that are collectively called as incretins.  The umbrella term incretins refers to a group of metabolic hormones (chemical messengers).  Most accurate examples of incretins are: GLP 1 (glucagon like peptide 1) and GIP (gastric inhibitory peptide).  These two are a part of the glucagon peptide family.  DPP4 breaksdown GLP 1 and GIP.

What do GLP and GIP (the two incretins do?)

GLP 1 and GIP (the two incretins) decrease glucagon blood levels and increase insulin blood levels.

K cells in the intestines secrete GIP and ‘L’ endocrine cells in the intestines secrete GLP 1.

a)      GLP 1 (a 30 amino acid peptide gut hormone)

-          stimulates beta cells in pancreas (Islets of Langerhans) to produce more of the blood glucose lowering hormone: insulin (the chemical messenger in blood that transfers glucose from blood into cells, thus, lowering blood glucose and ensuring glucose for cell energy production)

-          GLP 1 also increases beta cell mass in pancreas

-          GLP 1 inhibits glucagon secretion (thus overall GLP 1 helps in rapid postprandial decrease of blood glucose) (Glucagon is a hormone with opposite effects of insulin.  Thus, glucagon tends to increase blood sugar levels and insulin tends to decrease blood glucose levels.  Glucagon the peptide hormone is released in large quantities when blood glucose levels decrease below normal, glucagon stimulates liver to convert stored glycogen into glucose and this gets into the blood stream)

b)      GIP (a 42 amino acid gut hormone)

-          stimulates release of insulin

-          GIP helps promote growth and survival of beta cells of pancreas

-          GIP has a role in fat and bone metabolism

In a healthy body, the release of  insulin and glucagon from pancreas are in balance.

THUS, WHEN DPP4  proteinaceous enzyme BREAKSDOWN GLP 1 AND GIP - THE TWO INCRETINS; more glucagon is released and less insulin is produced from the pancreas.

WHAT ARE DPP4 INHIBITORS?

DPP4 inhibitors are a class of medicines that inhibit the enzyme DPP4, hence, degradation of incretins is decreased.  This in turn increases levels of the two incretins (GLP 1 and GIP), resulting in

-          decrease of glucagon release from pancreas

-          increase of insulin release from pancreas.

Thereby, DPP4 inhibitors have a hypoglycemic effect (lower the levels of blood glucose) and have application in Type 2 diabetes management.

Examples of DPP4 inhibitor drugs:

Sitagliptin (the first in this class), TENELIGLIPTIN (the most widely prescribed and sold, and most economical gliptin in India.  This is the only gliptin manufactured from API stage to formulation stage in India), saxagliptin, vildagliptin (currently the costliest gliptin in India), alogliptin and lindagliptin

Any side effects of DDPP 4 inhibitors (or incretin enhancers)?: the following may happen in some patients (not all)

-          Statistically significant increase in heart failure (scary?  Remember rofecoxib and pioglitazone controversies?  Sitagliptin the first DPP4 inhibitor was invented by Merck, the same people who invented rofecoxib!!), however, medical literature says there is overall good safety profile for gliptins

-          Diarrhea

-          Increased incidence of URTI (upper respiratory tract infections)

-          Sore throat

DPP4 inhibitors do not increase body weight nor cause hypoglycemic episodes.  Dosage adjustment is not normally required in case of renal stress and hepatic dysfunction.

GIP is also known as glucose dependent insulinotropic polypeptide.

Teneligliptin is a research product of Mitsubishi Tanabe Pharma, Japan and it was launched first in the world by both Tanabe Pharma and Daiichi Sankyo, in Sep 2012! (By the way, Daiichi Sankyo purchased the company Ranbaxy and sold it for a loss to Sun Pharma).  Teneligliptin is sold in Japan, Korea and India, currently.

In India, teneligliptin in Dec 2015 had 16 brands, with sales of Rs. 36 crores, in the Rs. 6000 crores antidiabetic market.  Glenmark has been taking risks and fighting for its share of pie in the hot antidiabetic gliptin market, its first tryst with gliptins being with sitagliptin (first gliptin in India from Merck).  However, Glenmark lost its patent battle for sitagliptin against Merck.  Not to be outdone, Glenmark bounced back into the gliptin market, with the third generation oral gliptin.  Teneligliptin is a hot market – because it has the most players, this is the only gliptin which is not under patent. The other patent protected gliptins: vildagliptin, saxagliptin, linagliptin and sitagliptin are not doing as great as teneligliptin.  So the age old adage, more the players, more the noise and market expansion occurs!  Hence, teneligliptin is the numero uno gliptin in India.  (Ref. for data: Business Standard, dated, 20.11.16, page no. 2).

Marketing of a branded formulation containing teneligliptin (hypothetical example):

On the basis of above target molecule knowledge one can successfully create a messaging campaign.  As is the works, brand name finalization, brand name font, CMYK and B/W colour standardization, brand logo or insignia concept and details, and brand audio signature tune (for digital and audio messaging strategy)…are finalized with brain storming sessions and sorting out the available choices in co-ordination with the design team.

Background:

Brand name: Tenali

Brand positioning statement: Enhances incretins, decreases blood glucose

Brand target audience:

a)      Type 2 diabetes patients (as monotherapy or add on)

b)      Endocrinologists, Consulting Physicians treating diabetes (diabetes specialists) and top GPs

Main brand messaging tools and methods:

a)      For MRs (field personnel): visual aid, leave behind literatures, reminder cards, stickers, eye catching theme based sample cartons, electronic visual aid page for use in tablet/mobile screen and short 60 second video film (mobile phone and tablet compatible)

b)      For medical journals: 1 page advertisement material

(Other marketing parameters in terms of number of target doctors, number of visits per month, courier marketing reminders, permission email marketing, other forms of permission based digital and mobile phone medium marketing, in-clinic activities, in-booth activities, in-pharmacy activities, CME activities and campaigns to be worked out too; based on planned activities suitable collaterals like leave behinds, patient information leaflets, die-cut literatures, reminder cards etc are also created)

Let us assume we also make a simple 1 page print visual aid copy for the teneligliptin brand to get a hang of the messaging concept.  There will, of course, be more visual aid pages highlighting safety, efficacy and utility of drug; however, here is just a one visual aid page sample:

State of art therapy for Type 2 diabetes patients

TENALI (Teneligliptin 20 mg tablets)

Enhances incretins, decreases blood glucose

Ø  Dependably inhibits DPP4 enzyme to decrease degradation of endogenous incretins: GLP 1 and GIP

Ø  Increases levels of GLP 1 and GIP to help restore normoglycemia, by reduced glucagon secretion and increased insulin release from pancreas

Ø  Additionally offers vasoprotection from ‘high blood glucose’ induced oxidative stress

‘Teneligliptin (Tenali) has antioxidant properties, ameliorates oxidative stress…caused by chronic exposure to high blood glucose by blood endothelial cells’ Ref.: Endocrine. 2016 Aug 16.

Recommend STATE OF ART THERAPY IN T2DM

TENALI (Teneligliptin 20 mg tablets)                                                          (PACK SHOT)

Enhances incretins, decreases blood glucose

Detailing story: Dr., season’s greetings, (pause) presenting the state of art therapy for Type 2 diabetes patients.  Please choose to recommend Tenali, teneligliptin 20 mg tablets (pause) enhances incretins, decreases blood glucose.

Tenali dependably inhibits DPP4 enzyme to decrease degradation of endogenous incretins: GLP 1 and GIP

Tenali increases levels of GLP 1 and GIP to help restore normoglycemia, by reduced glucagon secretion and increased insulin release from pancreas

Tenali additionally offers vasoprotection from high blood glucose induced oxidative stress, as per this reference, Tenali Teneligliptin has antioxidant properties, ameliorates oxidative stress…caused by chronic exposure to high blood glucose by blood endothelial cells.

Recommend state of art therapy in type 2 diabetes mellitus, Tenali, teneliglipin 20 mg tablets, enhances incretins, decreases blood glucose.

Above is the NUB OF THE MATTER APPROACH to understanding a drug from target molecule angle, and consequently developing a marketing messaging approach.  Please scroll to read below posts, and also recommend this blog to your acquaintances!  Click on older posts to continue reading.