Lixiana launch means UK doctors are 'spoilt for choice'

Daiichi Sankyo has launched its Lixiana product onto the UK market, where it becomes the fourth novel oral anti-coagulant (NOAC) available to treat and prevent clot-related disorders.

Lixiana (edoxaban) was approved by the European Medicines Agency last month to prevent stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) with one or more risk factors, such as congestive heart failure or hypertension, and also to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).

The once-daily Factor Xa-inhibitor has been on the market in Japan since 2011 and was also recently introduced to the US, where it is sold as Savaysa. It is competing with two other Factor Xa inhibitors – Johnson & Johnson/Bayer's Xarelto (rivaroxaban) and Bristol-Myers Squibb/Pfizer's Eliquis (apixaban) – as well as Boehringer Ingelheim's direct thrombin inhibitor Pradaxa (dabigatran).

All of the NOACs are seeing their use increase because they offer improved safety and ease-of-use advantages over older drugs such as warfarin, a vitamin K antagonist that requires regular INR (International Normalised Ratio) monitoring for coagulation status.

Daiichi Sankyo said the entry of the forth NOAC into the UK comes as a new patient survey shows a 'significant proportion still not receiving adequate treatment for AF', which is the most common heart rhythm disorder.

Professor Gregory Lip of the University of Birmingham, who was involved in the clinical trials of Lixiana, said clinicians are now "spoilt for choice with modern blood-thinning drugs that do not need INR monitoring and are easy for patients to live with."

A spokesman for Daiichi Sankyo indicated that the daily listed cost of Lixiana is £2.10, although he told pharmaphorum that "costs around the country may vary because of negotiated procurement discounts.

"This is because we recognise the need to provide value to the NHS by allowing more patients access to edoxaban," he added.

According to NHS data published earlier this year from Cambridgeshire and Peterborough Clinical Commissioning Group (CCG), that daily price puts Lixiana on a par with Xarelto and just slightly below the cost of Eliquis and Pradaxa, priced at approximately £2.20 per day.

The launch comes as the National Institute for Health and Care Excellence (NICE) has just issued new guidelines on the treatment and management of AF, which include routine reviews of how patients on vitamin K antagonists are faring and discussions between doctors – at least once a year – to gauge whether the drug they are on is working for them.

Daiichi Sanko's survey found that around 30 per cent of patients with AF in the UK are not given anticoagulant therapy at all, while among those prescribed drug treatment only around half were told different medications are available.

The survey also revealed that around 14 per cent of AF patients were taking aspirin, even though this is against guidance issued by NICE in June 2014 which said aspirin alone does not prevent stroke in AF patients but does increase bleeding risks.