Ironwood zeroes in on primary care doctors with new gout combo med Duzallo

What do constipation and gout have in common? Ironwood is leveraging its primary care sales force to hawk meds to treat both.

Before snapping up AstraZeneca’s gout franchise—including its centerpiece fixed-dose combo drug Duzallo, which won FDA approval earlier this week—the Massachusetts company had been looking for three or four years for a product to complement GI treatment Linzess.

And it found it. "The overlapping prescriber base is very high," Ironwood commercial chief Tom McCourt said of Linzess and the gout lineup, which also includes Zurampic. "Those high writers of Linzess also tend to be high writers of gout treatment," he noted in an interview, and "to be able to pull this in right next to Linzess in our bag makes our selling effort far more productive."

As the company comes out of the gate with Duzallo, it’ll be fielding roughly 300 reps calling on about 30,000 to 35,000 primary care physicians, "which we think is a good place to start," McCourt said. And along the way, "we’ll be evaluating how promotionally sensitive that group is and then evaluating if we’re at the right scale or not."

Ironwood is expecting big things for Duzallo, which it predicts can cue $300 million in annual peak gout sales. That’s significantly more than Zurampic has been pulling in; Barclays analyst Geoff Meacham expects the latter med to generate just $10 million this year.

Duzallo, though, combines Zurampic with allopurinol, a compound that fights the excess uric acid in the blood that’s associated with gout. McCourt predicts it should be a "far more attractive solution," for both doctors and patients. Allopurinol currently controls about 90% of the market, he said.

"This is such a simple solution for primary care. One pill once a day to get twice as many people to goal is a wonderful offering," he said.

Ironwood hasn't yet set a price on Duzallo, but McCourt said, "You can expect it to be quite comparable to what we saw with Zurampic."

It'll need to be. Payers have been leery of paying extra for combo meds, and Duzallo will already be facing allopurinol, a standard treatment that's available as a cheap generic.

Ironwood figures allopurinol's limitations give Duzallo an edge, though. And the market opportunity is certainly there. Of about 8 million U.S. patients who suffer from chronic gout, about 2 million are actively receiving treatments that aren’t getting it done, McCourt said. He attributes that number, in part, to a lack of innovation in the market. Physicians, particularly primary care physicians, have managed patients by administering allopurinol and later treating flare-ups, rather than preventing them from the outset. They're "largely ... pretty complacent," McCourt said.

Now, though, Ironwood has "the opportunity to take it to the next level," McCourt said, particularly as fellow gout drugmaker Takeda gets ready to face generics to its Uloric. Ironwood figures it’ll "probably be the dominant player" for the next five to seven years.

"Because we’re going to be here alone, we’re going to be doing this in a very thoughtful, very data-driven, very facts-driven" way as far as "how we inform our investments," McCourt said of the launch. "We want to be able to own that space."