Is Tamiflu 'better' than Relenza?

I can find no clinical evidence that Roche's Tamiflu is more effective than GlaxoSmithKline's less-prescribed Relenza against Type A influenza like H1N1 and H5N1.

Japanese health inspector in goggles, mask, gloves and gown interviews passengers on a flight arriving in Tokyo from the U.S. on May 2, 2009

I have found abundant evidence, however, that Switzerland-based Roche has run marketing circles around U.K.-based GlaxoSmithKline (GSK) by emphasizing the convenience of swallowing a Tamiflu capsule over the hassle of inhaling Relenza powder.

That's the only reason I can imagine why a dose of Tamiflu is two to three times as expensive as a dose of Relenza. A dose of 75mg Tamiflu costs US$5 to US$10 at Internet pharmacies, but a dose of 5mg Relenza costs only US$2.50 to US$3.50. Both require prescriptions.

If the target population covered by your business continuity plan includes a large number of children, you will prefer a Tamiflu caplet that is easier for children to swallow. But, for adults, inhaling Relenza is just as effective, much less expensive, and more readily available than Tamiflu at doctors' offices and pharmacies in Asia.

If this isn't a business school case study in the importance of packaging, it surely will be.

As long ago as August 2005, British science journal The Lancet published an article that said Relenza was just as effective as Tamiflu and caused fewer side effects. There is an U.S. Food & Drug Administration (FDA) report of serious psychiatric side-effects on children in Japan that may have resulted from taking Tamiflu. Recently, I also read reports of evidence that humans are developing resistance to oseltamivir (Tamiflu). No reports of similar side-effects from or resistance to Relenza exist, yet.

The scientific and commercial histories of the drugs are remarkably similar. Both oseltamivir phosphate (Tamiflu) and zanamivir (Relenza) are neuraminidase inhibitors (NAI's). Neuraminidase is a protein on the surface of an influenza virus that enhances its ability to scatter scraps of virus to infect other cells.

Both drugs were invented by small biotech companies: oseltamivir phosphate by San Francisco-area Gilead Sciences, and zanamivir by Melbourne, Australia-based Biota Holdings (ASX: BTA).

Both Gilead and Biota licensed their products to pharmaceutical giants in order to fund their expensive R&D. Biota licensed zanamivir in 1990 to Glaxo Wellcome (later GlaxoSmithKline) for 7 percent royalties on worldwide sales. Zanamivir underwent five years of trials, and Relenza was a "hit" when it was launched in 1999. But, four years later in 2003-2004, Biota received just A$1 million (USD$750,000) in royalties from GSK.

On the other hand, Gilead licensed oseltamivir to F. Hoffmann-La Roche (known as "Roche" in the United States) six years later, in September 1996. They obviously learned some lessons from Biota's experience. Gilead receives 14 percent to 22 percent royalties on Roche's worldwide sales of Tamiflu. Those royalties amounted to US$340 million in 2007 when worldwide sales of Tamiflu were 2.1 billion Swiss francs (US$1.8 billion).

Both Gilead and Biota were (initially) unhappy with their marketing partners' anemic marketing efforts, but only Biota went to court. Biota sued Glaxo in May 2004 for A$300 million in back royalties; Glaxo responded: "We lost a lot of money promoting it... The demand wasn't there."

Both GSK and Roche pointed out, in their defenses, that doctors and patients prefer to prevent influenza infections with annual vaccinations rather than treating influenza by swallowing or inhaling antiviral drugs like Tamiflu and Relenza. Both drugs are prescribed for prevention as well as treatment.

In November 2005, Roche and Gilead Sciences agreed to share control of production and sales of Tamiflu. Biota eventually settled with Glaxo in July 2008 for just A$20 million (US$15 million).

Sales of antiviral drugs got a shot in the arm, if you will, in 2006, when the avian influenza--"bird flu"--epidemic broke out in Asia. Suddenly…ahhhh...choo!...there were billions of potential patients, almost overnight. Roche struggled to meet explosive global demand. Sales of Tamiflu quintupled from US$290 million in 2004 to US$1.4 billion in 2005, and doubled again to US$2.3 billion in 2006. Roche estimated in January 2009 that governments around the world have stockpiled 220 million doses of Tamiflu.

Relenza's sales in 2006: US$32 million. And in 2008? US$103 million.

Tamiflu sales declined as fear of a highly-pathogenic strain of influenza abated. Pharmaceutical Business Review reported in February 2009 that sales of Tamiflu had plummeted to US$525 million in 2008 as "flu hype" faded.

Then, along came the Type A H1N1 influenza virus. In the last week of April, when the "swine flu" panic began, U.S. doctors wrote 270,000 prescriptions for Tamiflu & Relenza, more than 30 times the previous week. The 257,000 prescriptions for Tamiflu dwarfed the 13,700 for Relenza.

But, there is hope for GSK's "Little Inhaler That Could", after all. Bloomberg reported in April that sales of Relenza to governments surpassed those of Tamiflu for the first time, indicating that public sector health authorities and emergency managers are diversifying their stockpile risk.

The frenzy among national governments over the last three years to acquire stockpiles of Roche's Tamiflu has been simply a marketing triumph for Roche. What a difference packaging, timing and a little luck can make.

The original version of this article, published in July 2006, is available at Favorite flu fighters: Tamiflu or Relenza?. Additional articles about infectious disease planning in BCP Confidential include: Unmasking the truth, Stocking up on orifice supplies and India influenza outbreak portends pandemic.

• Talkback
• Print
• E-mail
• Share
• Alerts

• Is business continuity a dead-end?
• BCM standards, and standards for standards
• Ultimate 2012 recovery site: the moon
• Sample influenza business continuity plan
• No blood test for influenza

• Sample influenza business continuity plan
• Getting tested for H1N1 flu in Singapore
• Is Tamiflu 'better' than Relenza?
• Singapore BCM Standard SS540: TR19 with a facelift
• Ultimate 2012 recovery site: the moon

2010

2009

2008

2007

2006

• Open source blog reloaded!
• How the Sun continues to rise
• No room for e-polls failure
• Tiger Woods and his SMS
• Why aren't product recalls popular in India?

Nathaniel Forbes

Nathaniel Forbes is the director of Forbes Calamity Prevention, a Singapore-based consulting firm providing business continuity, crisis management and emergency response advice and training to multinational companies, with a focus on companies with offices in Asia. The firm is 10 years old. FCP's current and past clients include Singapore Exchange Ltd, OCBC Bank, AXA Insurance, The Gillette Company, Siemens and ABN Amro Bank. A former President of the Singapore Computer Society’s Business Continuity Group, Nathaniel passed the DRII’s Certified Business Continuity Planner (CBCP) examination in 1997. He has lived, traveled or worked in Asia since 1973.