Let the gushing begin. The new son-of-Plavix, Brilinta, beat Plavix in a randomized trial, published this week.

Plavix is a leading blood thinner given to patients after a heart attack or stent procedure. Only problem is that it's set to go off patent in 2011, leaving AstraZeneca needing to fill a $6 billion/year revenue hole.

Looks like Brilinta is all but inevitable. The incremental benefit is 1.9%, leaving insurance pharmacy benefit managers having to scratch their heads over whether a 1.9% benefit is worth billions of dollars in incremental drug spending.

This is analogous to the trouble with Aromatase Inhibitors in oncology: a 3% benefit in breast cancer costs $3 billion extra per year, and may be a 0% benefit if we were only smarter about which patients should take tamoxifen (see other post for that whole schpiel).

I'm not entirely convinced that Plavix is that much better than aspirin, and now we are having to accept son-of-Plavix as reasonable too.

This hasn't stopped the gushing from the thought leaders: WebMD reported this today: '"This is a blockbuster paper. ... [Brilinta] looks like the next big thing," Kirk Garratt, MD, clinical director of Lenox Hill Hospital in New York.'