Physician Views Results: IMPERIAL study data encourages existing high DCB/DES-prescribers; also likely to ramp up conversion

Boston Scientific made a big claim that the IMPERIAL study will have a "practice-changing" impact, following the euphoria at the Transcatheter Cardiovascular Therapeutics (TCT) meeting when the study results demonstrated the superior performance of its Eluvia drug-eluting vascular stent over another rival DES, Zilver PTX, in treating peripheral arterial disease (PAD) patients.

Feedback from the 41 physicians in the US and EU3 (UK, France and Germany) who were snap-polled by FirstWord Medtech earlier this week suggests that Boston Scientific may have grounds for its bullish outlook, and that the study results will accelerate the conversion from non-drug-device approaches, like plain old balloon angioplasty (POBA) and bare metal stents (BMSs), to drug-device combinations like DESs and drug-coated balloons (DCBs).

Current penetration of DESs/DCBs already high in peripheral intervention

We first tried to ascertain current prescribing practices by asking our sample of physicians what percentage of femoropopliteal disease patient population do they treat with non-drug-based interventions, like POBA and bare-metal stents, and what percentage with DCBs, like Medtronic's In.Pact, or with a DES, like Cook‘s Zilver PTX (Zilver PTX was highlighted rather than Eluvia as the former was the first DES approved for vascular intervention and has been on the market since 2012).

Looking at the treatment ratios in the responses, our analysis showed that just under half - 49 percent - of physicians in our sample are treating a higher proportion of PAD patient with DESs and/or DCBs than they do with POBA/BMS.

Some 41 percent continue to lean towards non-drug-device approaches, while 10 percent say they use both treatment approaches equally.  

This suggests that the tide is already turning for a BMS-to-DES/DCB conversion, which could only help makers of these drug-device products.

Physicians are lukewarm towards POBA/BMS performance

While 41 percent of physicians said they use more POBA/BMS to treat their PAD patients, this does not quite tally up with the level of satisfaction with these treatment modalities. When asked to rate how satisfied they were, on a scale of 1 to 5 (1 being not satisfied to 5 being very satisfied), with the traditional non-drug/device approaches, 54 percent gave a lukewarm satisfaction rating of 3, 7 percent gave a lower satisfaction rating of 2, and only 37 percent gave higher satisfaction ratings.

IMPERIAL study data could galvanise DES conversion

Nearly three-quarters of respondents - 73 percent - indicated they are likely to switch from POBA/BMS to DESs and other drug-based approaches following the results of the IMPERIAL study, which could only be good news for DES and DCB makers. There was a small proportion that seems undecided - 22 percent gave a conversion likelihood rating of 3 - and only 5 percent of respondents seemed unconvinced, giving a rating of 2.

DES conversion on the move, but ramp-up likely to happen

Speaking at Boston Scientific's cardiovascular business update meeting at the TCT meeting, Jeff Mirviss, president of the company's peripheral interventions division, indicated that the IMPERIAL study results are further proof of the clinical efficacy of DESs in PAD patients and should cast even more doubt on the role of BMSs as a default therapy for this patient population. Why shouldn’t DESs in PAD go the way of coronary DESs, where these drug-eluting devices overtook their bare-metal counterparts and continue to dominate the market, Mirviss postulated?

It was noted during Boston Scientific's business update meeting that Cook Medical's Zilver PTX has already been on the market for some years, and the speed of adoption has not been as fast as expected.

Boston Scientific responded that Eluvia was designed specifically for use in the superficial femoral artery, so the device boasts features - acute handling and easy deployment, among other things - that are an improvement over Zilver PTX, which was not designed for peripheral use, but was leveraged from another indication.  

Our snap-poll did ask physicians what specific features would make them switch from Zilver PTX to Eluvia. Of those who had experience with those two brands and did provide comment (many respondents said they did not know), restenosis rates of the stents came up as an important factor, as did easy deliverability and handling, among other things.

The results from this snap-poll suggest that this shift is already happening and DESs already hold sway in a significant portion of physicians' peripheral intervention protocol. The IMPERIAL data look to be further encouragement for this group of high-prescribers and, with a large pool of physicians with lukewarm feelings towards non-drug-based approaches, these could potentially be swayed to join the wave of change.

Download the full results here

As always, FirstWord would very much like to receive your feedback and suggestions.

Note: FirstWord Polls are powered by MedePolls, a fast-turnaround service to conduct instant polls of up to five questions with guaranteed samples that include physicians from dozens of specialities and over 100 markets (for further information click here).

Disclaimer: FirstWord follows market research best practices in conducting its Physician Views polls. However, Physician Views results should be considered directional and clients should use their market research resources for statistical analysis and conclusions required with very high confidence levels.

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