2010 Gastroenterology Fantasy Formulary Survey

Posted by Jeff Berk; BOLT International



Good evening, peepers and peepses.  Hope everybody had a great weekend.  So tonight I want to talk tangentially about forecasting, and i (eventually, once I’m done rambling) want to do it by using inflammatory bowel disease as an example; so Crohn’s and ulcerative colitis.  If you ask Joe Smartypants MBA at Goldman Sachs, he will tell you that forecasting is an incredibly complex task, and only he knows the magic algorithm to predict what’s going to happen a year from now.  But actually, some forecasting doesn’t take all that much schooling.  For instance, here’s the forecast for the next four days in Snottsdale, AZ.  Lemme tell you a little secret:  It’s also the forecast for the four days that follow those.  And if I add a 1 to each high, we’ll have the forecast for the four days after those.  Anybody want to bet a martini that say, within 3 degrees, the high on June 13th 2012 in Snottsdale is going to be 103?  AND that it’s going to be… Sunny?  BTW, since one should never include symbols without a legend, for those of my readers in Burlington, VT, those yellow dots on the photo represent THE SUN.  One other note on the photo; that cloudy looking thing on Sunday is smoke blowing down from the campfire which we’ve inherited from some dumba$$ Out of Staters.  We don’t have “clouds” as you know them; at least not in June.  And frankly the only Out of Staters who would be in AZ this time of year are, by definition, dumba$$es, so I apologize for being rhetorical in the sentence above.


So we’re here to talk about inflammatory bowel disease.  Well, I’ll talk (with my fingers) and you’ll listen (with your eyes).  It’s ZEN, Grasshopper.  Anyway… BOLT just completed the interviews for our 12th Gastroenterology Thought Leader panel, and will be sending that to the paying clients “soon” (like, as soon as I proof it).  But a couple of weeks ago one of my blogger groupies said to me during a private conversation (yes, I’m VERY SURE that she’s not 17 years old) that she  really liked when I published results from our Fantasy Formularies, and since I’m going to be releasing all new Gastro data this week, I’m happy to dump some reference data from last year.


What is a Fantasy Formulary, you might ask?  Well, it’s an exercise that we do that forces our Thought Leaders to rank all of the molecules in the clinical development pipeline.  They in effect have to split up an imaginary pot of their own money and bet on what they think will be the most successful new drugs; once they launch.  The Thought Leaders love this exercise, by the way, because they get to see everybody else’s bets.  Some people play this game with presidential candidates.  Some do it with gangsters (oops, I meant, “football players who think that elastic bands will support their illegal concealed carries, and who think that by some quirk of the universe, when they pull the trigger with the safety off and a round in the pipe, there won’t be repercussions following the percussion”).  We do it with drugs.


So I lay out the rules of the game below, and then give you one of the tables of results from the report we published last summer.  I want to note one anomaly; that being tofacitinib.  As you can see, while the drug made the list last year, it was in my humble opinion “undervalued” by my Panel.  Keep in mind that all answers were unprompted, so these had to be drugs that the Panelists had thought about; the cream of the crop from EVERYTHING that they have heard of for IBD.  But I think that this drug was on the cusp of people’s radar back then, and I can tell you that it is higher, a lot higher, this year.  Tofacitinib is going to radically alter prescribing for ulcerative colitis.  I’m talking after 5-ASA but before Remicade.  For reasons I’m not going to spell out in this blog, I think that the number you see from last year doesn’t reflect how popular it is with our Panel this year.  I know, that’s being a little bit coy.  Tough.  This blog is free, and you’re getting more than you paid for.  And for the record, I own what some would call a meaningful quantity of Pfizer stock.  I’ve owned it for years, and have no idea what Joe Smartypants thinks it’s worth.  Mine is on dividend reinvestment.

“Will ya develop writer’s cramp already?  You’re not even that funny.  Give us free stuff already or we’re gonna….”.

Okay. you don’t have to be rude  (unless you’re from New York, in which case I guess it’s in the water or something).  I’m officially done rambling for tonight…  Here ya go:



Gastro Fantasy Formulary Ground Rules and Scoring

  • The cohort for this thought exercise consisted of 6 North American Thought Leaders.  All Panelists were blinded from each other, and remain so.
  • Each Panelist was asked to consider all possible pharmacotherapies in development for inflammatory bowel disease (ulcerative colitis and/or Crohn’s).
  • Panelists were asked to list out the five new products that they most wanted to be on their Fantasy Formulary.  These should be new products that would fill an unmet need.
  • Panelists were to consider efficacy, safety and convenience.  Cost was not to be a factor.
  • The products could be on the market in their home country but they could not yet be approved for a gastrointestinal application.
  • Panelists were asked to cite a specific compound if they were aware of one and they could divulge information on it without violating existing confidentiality agreements.  Otherwise identifying a class was acceptable.
  • Panelists were allowed to have more than one drug in a class.  For example, a Panelist could choose vedolizumab AND RhuMAb b7, as long as the favored rank was specified.




  • The following scoring system was used to analyze the results of this exercise:
    • Each Panelist’s top drug was assigned a weight of 5 points; his 2nd favorite assigned 4 points, etc, through his top five list.  As noted, two Panelists only chose 4 drugs.
    • Drugs were assigned 2 points for each time they appeared on any TL’s formulary.  This reflects the importance of broad consensus that a drug would be important in the next few years.
    • For drugs with the same score, appearing on more top-five lists was the weighting factor first used to break the tie.
    • The second tie-breaking weighting factor was highest position achieved on any Panelist’s list.


  • Because there was generally not enough strong support for one future brand vs. another, we use classes in the scoring, vs. specific products within the class.



Table 1:  Preferred Product Class

Categories: Crohn's disease, gastroenterology, inflammatory bowel disease, ulcerative colitis
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