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Title: PharmaNote
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Place of Publication: Gainesville, Fla.
Publication Date: September 2010
Copyright Date: 2010
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Pharma o e'


VOLUME 25, ISSUE 1 2 SEPTEMBER 201 O


Ustekinumab is a human IgG1K monoclonal anti-
body with high affinity and specificity for the p4~0 pro-
tein subunit shared by IL-12 and IL-23 cytokines.
Ustekinumab inhibits these cytokines from binding to
the shared receptor, IL-12RP1, on the surface of im-
mune cells. IL-12 and IL-23 mediate inflammatory
processes in psoriasis through the development of a
novel T-cell subset, T-helper 1 cells, differentiation of
CD4+ T-cells and activation of natural killer and CD4+
T-cells.1,2,6

PHARMACOKINETICS

The pharmacokinetics of ustekinumab are listed in
Table 1. Although its metabolism has not been eluci-
dated, ustekinumab is likely catabolized into its re-
spective amino acids and peptides. Lower median se-
rum concentrations occur in subjects 1100 kg com-
pared to subjects weighing >100 kg.6
Ustekinumab is a pregnancy category B drug; ani-
mal studies have not resulted in significant adverse
outcomes. Although there is unknown risk to infants of
nursing mothers receiving ustekinumab, it has been
detected in the milk of lactating monkeys. Addition-
ally, since IgG is excreted in human milk, the assump-
tion is that this IgG1K monoclonal antibody will be ex-
creted as well. When compared to young adults, differ-


with a T-lymphocyte mediated pathogenesis.
This condition presents with lesions character-
ized by sharply demarcated, erythematous plaques
covered with silvery scales. Psoriasis affects 1.4 to
4.6%/ of the U.S. population, or approximately 7.5 mil-
lion Americans.1-4 Annual incremental direct and indi-
rect costs amount to $900 and $600 per patient, re-
spectively. Additionally, the annual cost to society due
to absenteeism and lost productivity sum to $9.9 bil-
lion, or $2961 per worker.s
The treatment of psoriasis depends on its level of
severity. Mild psoriasis is treated with topical therapy
including retinoids, corticosteroids and coal tar. Mod-
erate to severe disease is treated with phototherapy or
systemic therapy including methotrexate, cyc-
losporine, acitretin or biologics.3"
Ustekinumab (StelaraTM) is a new biologic treat-
ment indicated for adults 18 and older, with moderate
to severe psoriasis, who are otherwise eligible to re-
ceive phototherapy or systemic treatment. Ustekinu-
mab is marketed by Centocor Ortho Biotech Inc. and
received FDA approval in September of 2009.6,7
The objective of this article is to review the phar-
macology, pharmacokinetics, clinical trial data, safety,
dosing and cost of ustekinumab.

PHARMACOLOGY





mm .


INSIDE THIS ISSUE*

USTEKINUMAB: A NEW TREATMENT
APPROACH FOR PSORIASIS


Volume 25, Issue 12 September 2010


PharmaNote


U~ST'EKIN UMPAB:: A NEW V
TREATMENT APPROACH FOR
PSORIASIS

Jessica Bovio, Pharm.D. candidate







Table 1. Pharmacokinetics of ustekinumab.6
UST 45 mg UST 90 mg
Tmax: 13.5 days Tmax: 7 days
Absorption
Trough [SS]: 0.31 mcg/mL Trough [SS]: 0.64 mcg/mL
Distribution Vd: 161 mL/kg Vd: 179 mL/kg
Metabolism NC NC
Cl: 1.90 to 2.22 mL/day/kg Cl: 1.90 to 2.22 mL/day/kg
Elimmnation
tl/2: 14.9 to 45.6 days tl/2: 14.9 to 45.6 days


ences in pharmacokinetics, safety and efficacy are not
evident in the elderly population receiving ustekinu-
mab. Data are not available in special populations in-
cluding those with hepatic or renal impairment, as
well as in pediatrics.6
Drug interaction studies have not been performed
for ustekinumab. Although its metabolic pathway is
unclear, it is not expected to interact with other dugs.
However, the potential effect of cytokines on CYP4~50
enzymes requires cautious use and potential monitor-
ing with concomitant therapy of CYP4~50 substrates
with narrow therapeutic indices. Additionally, live vac-
cines should not be administered with ustekinumab;
tuberculosis BCG vaccines should be avoided during
treatment as well as one year prior to and one year
after therapy. Although immunosuppressants and pho-
totherapy are indicated for moderate to severe psoria-
sis, there are no data to support concurrent use with
ustekinumab.6

CLINICAL TRIALS

Five clinical trials were conducted in the develop-
ment of ustekinumab: two phase 1 trials, one phase 2
trial and two phase 3 trials.8-12 Additionally, a third
phase 3 trial was conducted to compare ustekinumab
and etanercept, another biologic used for the treat-
ment of moderate to severe psoriasis [Table 2).13 All
trials used the Psoriasis Area and Severity Index
(PASI) score which is a measure of the percent of body
surface area affected, as well as gradation of erythema,
induration and scaling. Response to treatment is iden-
tified as PASI-75, a 75% reduction in the PASI score.14
Ustekinumab received approval following comple-
tion of the two phase 3 multicenter, randomized, dou-
ble-blind, placebo-controlled trials: PHOENIX 1 and
PHOENIX 2.
PHOENIX 1, a 76-week study, evaluated the safety
and efficacy of ustekinumab in adult subjects eligible
for phototherapy or systemic therapy, diagnosed with
plaque psorasis for at least 6 months, and having a
PASI score of 12 or higher. The primary endpoint was


the proportion of subjects achieving a PASI-75 at 12
weeks. The study was performed in different phases: a
placebo-controlled phase from weeks 0 to 12, a pla-
cebo-crossover and active treatment phase from
weeks 12 to 40 and a randomized withdrawal phase
from weeks 40 to 76. Upon random allocation to treat-
ment groups, subjects received ustekinumab 45 mg or
90 mg at 0 and 4 weeks and then every 12 weeks. Sub-
jects randomly assigned to the placebo group received
placebo at 0 and 4 weeks with subsequent crossover
randomization at 12 weeks, with half the subjects to
45 mg and the other half to 90 mg, followed by placebo
retreatment during weeks 40 to 76. At 40 weeks, sub-
jects initially randomly assigned to receive active
treatment who achieved PASI-75 at 28 and 40 weeks
were re-randomized to continue active maintenance
therapy or received placebo until no response was
present. Subjects with little or no response at these
specified times either discontinued treatment or re-
ceived treatment more frequently in 8 week inter-
vals.ll
The primary endpoint at 12 weeks was signifi-
cantly higher in both active treatments groups com-
pared to placebo. The response rates for the 45 mg
versus placebo group were 67.1% and 3.1%
(p<0.0001), respectively. The response rates for the 90
mg versus placebo group were 66.4%/ and 3.1%
[p<0.0001), respectively. Maximum efficacy was
achieved at week 24 in both active treatment groups.
Upon re-randomization at 40 weeks, PASI-75 mainte-
nance was significantly better in maintenance therapy
groups compared to those withdrawn from therapy
(p<0.0001). In the maintenance therapy groups, me-
dian percentage improvement in PASI scores re-
mained stable until 76 weeks. Rebound psoriasis
events and rates were not reported, however subjects
withdrawn from therapy had a median time to loss of
PASI-75 of about 15 weeks. Additionally, subjects who
re-initiated active treatment achieved PASI-75 scores
within 12 weeks.ll
Similar to PHOENX 1, PHOENIX 2, a 52-week study,
evaluated the safety and efficacy of ustekinumab in
subjects with the same inclusion criteria and primary


Volume 25, Issue 12 September 2010


PharmaNote






















































































PharmaNote


Table 2. Summary of ustekinumab clinical trials.8-13,15,16


Dose


AC = active comparator; ACR20 = 20% improvement from baseline in the American College of Rheumatology measures; CDAl = Crohn's disease
activity index; CO = crossover; DB = double-blind; DE = dose-escalating; ETA = etanercept; IV = intravenous; MC = multicenter; NR = non-
randomized; OL = open-label; PC = placebo-controlled; PCB = placebo; R = randomized; SA = single administration; SB = single-blind; SC = subcu-
taneous; UST = ustekinumab; YO = years old.
a. p<0.001 vs. PCB
b. p<0.0001 vs. PCB
c. p=0.01 vs. ETA
d. p<0.001 vs. ETA
e. p=0.0002 vs. PCB
f. p=0.34 vs. PCB


Trial
Kauffman, et al.
(2004)






Gottlieb, et al."
(2005)





Krueger, et al.io
(2007)





Leonardi, et al.l (2008)


Design
S16-week, first in human, NR, OL, SA,
DE, phase 1 trial
-Subjects with mean duration of dis-
ease 13.6 to 19.7 years (n=18)
-Primary objective: clinical response
of single, ascending, IV administra-
tion
-24-week, MC, R, DB, PC, phase 1 trial
-Subjects with moderate-severe pso-
riasis (n=21)
-Primary objective: clinical response
of single, ascending, SC doses


-32-week, MC, R, DB, PC, phase 2 trial
18 YO with moderate-severe pso-
riasis (n=320)
SPrimary end point: proportion of
subjects achieving PASI-75 at week
12
-76-week, MC, R, DB, PC, phase 3 trial
18 YO with moderate-severe pso-
riasis (n=766)
SPrimary endpoint: proportion of
subjects achieving PASI-75 at week
12


Results
PASI-75 at week 16:
-1 (25%)
-2 (50%)
4 (80%)
S5 (100%)



PASI-75 at week 24:




4 (100%)
0 (0%)
PASI-75 at week 12:
33 (52%)a
38 (59%)a
43 (67%)a
52 (81%)a
-1(2%)
PASI-75 at week 12:
- 171 (67.1%)b
- 170 (66.4%)b
-8 (3.1%)


- UST 0.1 mg/kg (n=4)
- UST O.3 mg/kg (n=4)
- UST 1.0 mg/kg (n=5)
- UST 5.0 mg/kg (n=5)




- UST O.3 mg/kg (n=5)
- UST 0.75 mg/kg (n=4)
- UST 1.5 mg/kg (n=4)
- UST 3.0 mg/kg (n=4)
-PCB (n=4)


- UST 45 mg, 1 dose (n=64)
- UST 90 mg, 1 dose (n=64)
UST 45 mg, multidose (n=64)
- UST 90 mg, multidose (n=64)
-PCB(n=64)


- UST 45 mg (n=255)
- UST 90 mg (n=256)
SPCB (n=255)


Papp, et al.12
(2008)





Griffiths, et al. 3
(2008)





Gottlieb, et al.1s
(2009)




Sandborn, et al. *
(2008)


-52-week, MC, R, DB, PC, phase 3 trial
- 18 YO with moderate-severe pso-
riasis (n=1230)
SPrimary endpoint: proportion of
subjects achieving PASI-75 at week
12
S64-week, MC, R, SB, AC, phase 3 trial
- 18 YO with moderate-severe pso-
riasis (n=903)
-Primary endpoint: proportion of
subjects achieving PASI-75 at week
12
-36-week, MC, R, DB, PC, phase 2 trial
- 18 YO with active psoriatic arthritis
(n=146)
-Primary endpoint: ACR20 response
at week 12
S28-week, MC, R, CO, DB, PC, phase
2a trial
-Adults with moderate-severe Crohn's
disease (n=104)
SPrimary endpoint: clinical response
of 25% reduction and 70 points from
baseline CDAl at week 8


PASI-75 at week 12:
- 273 (66.7%)b
311 (75.7%)b
- 15 (3.7%)



PASI-75 at week 12:
- 141 (67.5%)c
- 256 (73.8%)d
- 197 (56.8%)



ACR20 response at week 12:
32 (42%)e
- 10 (14%)



25% reduction/70 points from base-
line CDAl at week 8:
49%f
40%


- UST 45 mg (n=409)
- UST 90 mg (n=411)
SPCB (n=410)




- UST 45 mg (n=209)
- UST 90 mg (n=347)
ETA 50 mg (n=347)




- UST 63 or 90 mg (n=76)
- PCB (n=70)





- UST 4.5 mg/kg and 90 mg(n=51)
- PCB (n=53)


Volume 25, Issue 12 September 2010







Table 3. Adverse Events at 12 Weeks in the PHOENIX 1 and PHOENIX 2 Trials."
PHOENIX 1 PHOENIX 2

Placebo UST 45 mg UST 90 mg Placebo UST 45 mg UST 90 mg
(n=255) (n=255) (n=255) (n=410) (n=409) (n=411)
URTI 16 (6.3%) 18 (7.1%) 16 (6.3%) 14 (3.4%) 18 (4.4%) 12 (2.9%)
Nasopharyngitis 22 (8.6%) 26 (10.2%) 21 (8.2%) 29 (7.1%) 30 (7.3%) 28 (6.8%)
Arthralgia 7 (2.7%) 7 (2.7%) 6 (2.4%) 12 (2.9%) 14 (3.4%) 10 (2.4%)
Headache 6 (2.4%) 14 (5.5%) 13 (5.1%) 17 (4.1%) 19 (4.6%) 19 (4.6%)
Injection site erythema NR NR NR 1(0.2%) 6 (1.5%) 6 (1.5%)
Cough NR NR NR 7 (1.7%) 3 (0.7%) 4 (1.0%)
NR = not reported; URTI = Upper Respiratory Tract Infection.


to dose intensification in those receiving ustekinumab
45 mg. Subjects in the 90 mg arm also had significantly
higher response rates with 8 week versus 12 week
dosing [p=0.004). At week 52, this intensified treat-
ment arm converted two-thirds of the partial respond-
ers to PASI-75 responders.12
Although it has not received additional indications,
ustekinumab may have additional uses based on other
clinical trials. A phase 2 trial conducted for ustekinu-
mab use in psoriatic arthritis achieved significant re-
sults.ls Another phase 2 trial has assessed efficacy and
safety in Crohn's disease (Table 2). Although signifi-
cance was not achieved for the primary endpoint at 8
weeks (p=0.34~) in this trial, significance was evident
at 4 weeks (p=0.02) and 6 weeks (p=0.019), as well as
in a subgroup of previous infliximab users (p<0.05).16

SAFETY

Ustekinumab is well tolerated for 52 to 76 weeks.
Common adverse events reported in 21% of individu-
als, at week 12 of therapy, are shown in Table 3. Less
common adverse reactions included cellulitis and in-
jection site reactions.6,1,12
Serious adverse reactions reported include serious
infections, malignancies, immunogenicity, and reversi-
ble posterior leukoencephalopathy syndrome (RPLS).
Ustekinumab should not be administered if a patient is
at risk for or currently has an active infection, such as
tuberculosis. Additionally, individuals with genetic
deficiencies of IL-12 and IL-23 are more susceptible to
systemic infections, so diagnostic testing should be
considered. Since ustekinumab is an immunosuppres-
sant, inhibition of IL-12 and IL-23 may increase malig-
nancy risk. Safety in patients with a history of malig-
nancies has not been evaluated. Anti-ustekinumab an-
tibodies have rarely been reported in clinical trials;
however, immunogenicity may develop resulting in a


endpoint. The study was performed in different
phases: a placebo-controlled phase from weeks 0 to
12, a placebo-crossover and active treatment phase
from weeks 12 to 28 and a randomized dose intensifi-
cation phase from weeks 28 to 52. After allocation to
treatment groups, subjects received ustekinumab 45
mg or 90 mg at 0 and 4 weeks and then every 12
weeks. Subjects randomly assigned to the placebo
group received placebo at 0 and 4 weeks with cross-
over randomization to the 2 active treatments at
weeks 12, 16 and every 12 weeks thereafter. At week
28, partial responders to active treatment, defined as
those who achieved a PASI-50 but less than PASI-75,
were re-randomized to either continue receiving the
active treatment every 12 weeks or to receive intensi-
fied dosing, defined as 45 or 90 mg doses given every
8 weeks. Non-responders discontinued treatment at
week 28 and those with PASI-75 continued receiving
the 12 week maintenance dose.12
The primary endpoint at 12 weeks was signifi-
cantly higher in both active treatments groups. The
response rates for the 45 mg versus placebo group
were 66.7% and 3.7% (p<0.0001), respectively. The
response rates for the 90 mg versus place group were
75.7% and 3.7% (p<0.0001), respectively. Maximum
response was achieved at 20 weeks in both groups.
Upon random allocation from placebo to active treat-
ments, at week 12, response rates were similar to ini-
tial active treatment groups. PASI-75 responders at
week 28 who continued to receive maintenance ther-
apy continued to respond until week 52.12
Partial responders typically had higher body-
weight and longer duration of psoriasis. Compared to
12 week dosing, dosing intensification among all the
re-randomized partial responders did not improve
efficacy. Subjects in the ustekinumab 90 mg treatment
arm had a significantly greater number of visits with
PASI-75 response [p<0.014), despite lack of response


Volume 25, Issue 12 September 2010


PharmaNote





riasis. The dosage regimen and route of injection may
improve compliance and convenience in patients suf-
fering from psoriasis. Continued follow-up past a two
year interval is necessary to further define its safety
and efficacy profile. Current data reveal a promising
future for ustekinumab with potential secondary indi-
cations for treating psoriatic arthritis and Crohn's dis-
ease.


REFERENCES


1. Schon MP, Boehncke WH. Psoriasis. N Engl J Med
2005;352(18):1899-912.
2. Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med
2009;361(5):496-509.
3. National Institute of Arthritis and Musculoskeletal and
Skin Diseases. Psoriasis. Available at: http://
www.niams.nih.gov/Health_Info/Psoriasis/dfutap
Accessed April 3, 2010.
4. National Psoriasis Foundation. About Psoriasis. Avail-
able at: http://www.psoriasis.org/netcommunity/
about psoriasis. Accessed April 3, 2010.
5. Fowler JF, Duh MS, Rovba L, Buteau S, Pinheiro L, Lobo
F, et al. The impact of psoriasis on health care costs and
patient work loss. J Am Acad Dermatol 2008;59(5):772-
80.
6. Centocor Ortho Biotech Inc. Stelara (ustekinumab)
package insert. Horsham, PA; 2009.
7. Moderate or Severe Plaque Psoriasis Treatment STE-
LARA'". Available at: http://www.stelarainfo.com. Ac-
cessed April 2, 2010.
8. Kauffman CL, Aria N, Toichi E, McCormick TS, Cooper
KD, Gottlieb AB, et al. A Phase I Study Evaluating the
Safety, Pharmacokinetics, and Clinical Response of a
Human IL-12 p40 Antibody in Subjects with Plaque Pso-
TiaSIS. J Invest Dermatol 2004;123:1037-1044.
9. Gottlieb A, Frederick BS, Everitt DE, McCormick T. A
Phase I Study Evaluating the Safety, Pharmacokinetics,
and Clinical Response of a Human IL-12 p40 Antibody
in Subjects with Plaque Psoriasis (abstract). J Am Acad
Dermatol 2005;52(Csuppl):172.
10. Krueger GG, Langley RG, Leonardi C, Yeilding N, Guzzo
C, Wang Y, et al; CNTO 1275 Psoriasis Study Group. A
human interleukin-12/23 monoclonal antibody for the
treatment of psoriasis. N Engl J Med 2007;356(6):580-
92.
11. Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C,
Wang Y, et al.; PHOENIX 1 study investigators. Efficacy
and safety of ustekinumab, a human interleukin-12/23
monoclonal antibody, in patients with psoriasis: 76-
week results from a randomised, double-blind, placebo-
controlled trial (PHOENIX 1). Lancet 2008;371
(9625):1665-74.
12. Papp KA, Langley RG, Lebwohl M, Krueger GG, Szapary
P, Yeilding N, et al.; PHOENIX 2 study investigators. Effi-
cacy and safety of ustekinumab, a human interleukin-
12/23 monoclonal antibody, in patients with psoriasis:
52-week results from a randomised, double-blind, pla-


trend toward lower serum ustekinumab concentra-
tions and reduced response rate. Although RPLS was
only reported in one patient during clinical trials,
ustekinumab should be discontinued if a patient ex-
periences symptoms consistent with this neurological
disorder.6
At present, ustekinumab's safety and efficacy have
not been evaluated past a 2 year interval.6

DOSING &r ADMINISTRATION

StelaraTM iS supplied in single-use vials as well as
single-use prefilled syringes with needle safety guards.
Although injections must be performed by a health
care provider, its ease of administration and safety
features may one day permit self-administration.
Administration occurs subcutaneously through the
upper arms, gluteal regions, thighs or abdomen; sites
should be rotated for subsequent injections.
Phase 3 studies indicate that the optimal, initial
subcutaneous dose appears to be 45 mg for patients
weighing less than 100 kg and 90 mg for patients
weighing more than 100 kg. The same dose is given
throughout therapy with second doses given at 4
weeks and maintenance doses every 12 weeks there-
after.'

COST

According to CVS Caremark's Specialty TrendsRx@
Alert, the average wholesale price of StelaraTM iS
$5595.60 per 45 mg/0.5mL vial. The annual cost for
initial and maintenance therapy with this dose totals
$33,573.60.17
StelaraTM Support is available for qualifying pa-
tients. Individuals with private insurance are eligible
for the instant savings program which reduces co-pay,
deductible and co-insurance costs. These patients can
receive a savings card which entitles them to their first
3 doses at no cost; doses 4 through 6 require patients
to pay $50 for every $1,050 out-of-pocket expenses'
with a $3,000 maximum benefit. The program expires
after 12 months or 6 doses; however extended access
programs and instant rebates are available. Medicare
and Medicaid patients can be directed to independent
foundations through StelaraTM Care COordinators. Addi-
tionally, uninsured patients who meet financial and
medical criteria can receive assistance from the John-
son & Johnson Patient Assistance Foundation, Inc.7

SUMMARY

Ustekinumab is a safe and efficacious treatment
option for the management of moderate to severe pso-


Volume 25, Issue 12 September 2010


PharmaNote







cebo-controlled trial (PHOENIX 2). Lancet 2008;371
(9625):1675-84.
13. Griffiths CE, Strober BE, van de Kerkhof P, Ho V, Fidelus
-Gort R, Yeilding N, et al.; ACCEPT Study Group. Com-
parison of ustekinumab and etanercept for moderate-to
-severe psoriasis. N Engl J Med 2010;362(C2):118-28.
14. Scanlon JV, Exter BP, Steinberg M, Jarvis CI. Ustekinu-
mab: treatment of adult moderate-to-severe chronic
plaque psoriasis. Ann Pharmacother 2009;43:1456-65.
15. Gottlieb A, Menter A, Mendelsohn A, Shen YK, Li S,
Guzzo C, et al. Ustekinumab, a human interleukin 12/23
monoclonal antibody, for psoriatic arthritis: random-
ised, double-blind, placebo-controlled, crossover trial.
Lancet 2009;373(9664):633-40.
16. Sandborn WJ, Feagan BG, Fedorak RN, Scherl E, Fleisher
MR, Katz S, et al.; Ustekinumab Crohn's Disease Study
Group. A randomized trial of Ustekinumab, a human
interleukin-12/23 monoclonal antibody, in patients
with moderate-to-severe Crohn's disease. Gastroen-
terology 2008;135(4):1130-41.
17. CVS Caremark Specialty TrendsRx Alert. Stelara. Avail-
able at: https://www.caremark.com/portal/asset/
SpecialtyTrendsRxAlert_Stelara.pdf. Accessed April 5'
2010.




DRUTG UTPDATES


Table 1. Top Generic Drugs in 2009 by Total Rx.

% Change
Rank Drug Total Rx's from 2008

1 Hydrocodone/APAP 120,478,000 -0.6%
2 Lisinopril 74,544,000 6.8%
3 Simvastatin 72,966,000 21.3%
4 Levothyroxine 63,710,000 8.7%
5 Amoxicillin 51,430,000 -1.2%
6 Azithromycin 49, 902,000 1.3%

7 Hydrochlorothiazide 46,403,000 -1.4%
8 Amlodipine 45, 107,000 15.6%

9 Alprazolam 44,467,000 2.0%
10 Metformin 42,161,000 5.3%
11 Omeprazole 38,791,000 33.0%
12 Atenolol 37,973,000 -7.2%
13 Furosemide 36,774,000 -1.8%
14 Metoprolol 36,016,000 21.4%
15 Sertraline 30,508,000 3.5%

h ttp://drugtopics. modern medicine. com/drug- topics/da ta/
articlestarndard/drug topics/25201 0/674982/arrticle. pdf


IJ~ (


Table 2. Top Brand Drugs in 2009 by Retail Dollars.

% Change
Rank Drug Total Retail Dollars from 2008

1 Lipitor $5,363,193,000 -8.8%
2 Nexium $5,014,827,000 4.6%

3 Plavix $4,223,124,000 11.2%

4 Advair Dlskus $3,653,410,000 2.3%

5 Seroquel $3,117,591,000 7.2%

6 Abilify $3,083,351,000 30.0%

7 Singulair $3,027,378,000 4.5%

8 Oxycontin $3,020,239,000 20.7%
9 Actos $2,531,621,000 3.4%

10 Prevacid $2,508,555,000 -23.9%

11 Cymbalta $2,404,353,000 10.8%
12 Effexor XR $2,385,507,000 -10.2%

13 Lexapro $2,334,422,000 -3.2%

14 Crestor $2,308,138,000 37.7%

15 Zyprexa $1,855,436,000 6.1%
h ttp://drugtopics. modern medicine. com/drug- topics/da ta/
articlestarndard/drug topics/25201 0/264961/arrticle. pdf






The PharmaNote is Published by:
The Department of Pharmacy
Services, UF Family Practice Medical
Group, Departments of Community
Health and Family Medicine and
Pharmacotherapy and Translational
Research
University of Florida



John G. Gums Editor
PharmD, FCCP

R. Whit Curry, MD Associate Editor

Steven M. Smith Assistant Editor
Ph armD


Volume 25, Issue 12 September 2010


PharmaNote




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