How Covid-19 Brought These Drugs into Prominence

You have probably heard of Dolo 650. The antipyretic—a medicine used to treat fever and body ache—was in high demand in January 2022, cornering sales of Rs 51.79 crore or about 23.4 million strips, as per Pharmasofttech AWACS, a pharma market research company. Comparatively, in January 2021, sales were Rs 18 crore. In the 12-month period of January to December 2021 Dolo 650 clocked sales of Rs 417 crore (about 189.4 million strips) as per AWACS. Thanks to the Covid-19 pandemic, almost every household today is aware of the drug. Manufactured by Micro Labs, Dolo 650 was the most prescribed antipyretic during the third wave of Covid-19. “Whenever there has been outbreak of viral infections, Dolo 650 has seen spike in prescriptions and sales. Going by our past experience during the outbreaks of Chikungunya, H1N1 (Swine Flu) and Dengue, spike in sales of Dolo 650 during Covid-19 was expected,” says Jayaraj G., Executive Vice President-Marketing, Micro Labs. “Also, Dolo 650 found a place in the Covid treatment protocol of every medical agency. So, we expected a spike bigger than that of earlier outbreaks.”

But Dolo wasn’t the only regular drug that benefitted from Covid-19. It was among a range of multivitamins to antipyretics brands that came to the fore in January 2022, the peak of the third wave of the Covid-19 pandemic, and garnered high revenues for their companies. While the first wave of Covid-19 in April-May 2021 saw differing prescriptions being issued depending upon the severity of the infection, the third wave saw a fixed prescription circulating among patients, carrying a few standard medicines. Apart from Dolo, Zincovit, manufactured by Chennai-based Apex Labs, became the most selling multivitamin for managing Covid-19 patients. And Cipla’s Montair LC became the most prescribed anti-allergic medicine. In the previous waves, drugs like Remdesivir and Ivermectin, too, got good revenues.

Emerging Trends

Salil Kallianpur, former executive vice president of GSK Pharma, and now a pharma industry analyst and consumer behaviour specialist, points to certain trends that emerged during the Covid-19 waves. “The first trend was opportunistic brand launches where products like Remdesivir, Ivermectin and others suddenly took off as desperate people looked for them, hoping that these drugs would save lives. The most prominent of these launches was Fabiflu (Glenmark Pharmaceuticals’ brand of Favipiravir). Glenmark clocked `750 crore in less than a year for a product that had no scientific basis for use in Covid patients.” Kallianpur analyses that this trend wasn’t as prominent during the first wave, probably due to lack of a set treatment protocol and supply chain disruptions.

The second interesting trend was how (non-Covid-19 treatment) brands established over many decades were responsible for helping companies continue their growth in those tumultuous months. “While brands launched two to three years before the pandemic either lost demand or felt a drag on growth, the most established brands jumped in volume sales. Zincovit and Dolo stand out as examples. This re-establishes my view that strong marketing initiatives helped these products gain the trust of doctors, patients and their families,” says Kallianpur. For example, Cipla, the maker of Montair LC, in its third quarter results said that its overall business grew by 13 per cent year-on-year (YoY) led by sustained momentum across core therapies and traction in flagship brands, with modest contribution from its Covid-19 portfolio.

The Market Reflection Report for January 2022 from IQVIA, an American multinational market and data analytics company, says Azithromycin oral solids—used for managing certain bacterial infections ranging from bronchitis, pneumonia and infections of the lungs often occurring during Covid-19—saw 250 per cent growth this January. Among brands, Azithral—manufactured by Alembic Pharma—ranked No. 1 among the top 25 products in January (in comparison to December ’21), with Rs 73 crore of sales and growth of 27 per cent over December 2021, clearly indicating that the antibiotic was massively prescribed during the third wave of Covid-19. Apart from Azithral, among the top 10 brands, Dolo grew 307 per cent while Calpol, another antipyretic, grew 261 per cent.

Dissecting the trend, Kallianpur says that as overall inventory levels reduced due to distributors hesitating to book large orders, they clearly preferred to invest their working capital in brands that had strong demand and those they trusted would sell quickly. “Antipyretics like Dolo became more popular as word of mouth spread in a situation where people turned to friends, family and neighbourhood pharmacists for advice. The inclusion of the product by brand name in the Covid protocol helped quite a bit, but the new participative nature of people in their healthcare gave it strong tailwind,” he adds. Kallianpur also says that many brands in the wellness categories sold quickly. “In that wave, established pharma brands like Zincovit, Becosules, etc. also became popular.”

“For many years now, healthcare professionals have trusted the Becosules brand and encouraged the use of the many products in the portfolio to provide adequate amount of micronutrients,” says S. Sridhar, Managing Director of Pfizer Limited, which manufactures Becosules. “The pandemic has emphasised the importance of preventive health and the need to build immunity. Vitamin B complex and vitamin C are important for optimum functioning of our body, which is why we saw an increase in the use of Becosules during this time,” says Sridhar.

The scenario was quite different in the first half of 2021, when the second wave of the pandemic wreaked havoc on both patients and the medical community. At that time, the pharma industry had reasonable growth on account of Covid-19-related products like Remdesivir, and vitamins and minerals received a boost as supplemental products. Pharmaceutical experts believe that it also led to much better hygiene practices due to the adoption of Covid-19 appropriate behaviour. Due to this, the non-Covid-19 acute therapy business was impacted, but as the second wave started reducing, people started coming out of their homes and were exposed to the weather and seasonal changes.

On the other hand, the first wave of the pandemic, in terms of pharma sales trends, was similar to the third wave because nobody knew how to treat Covid-19. “The medical fraternity was not able to put its finger on the cause and hence wisely chose to treat the symptoms as best as it could. This period saw exponential growth in the sales of some very standard medicines like antipyretic drugs and supplements geared towards treating high grades of fever and boosting immunity. The likes of Remdesivir, Lopinavir-Ritonavir, Favipiravir, and such treatments became the primary line of treatment for critically ill patients,” says Raheel Shah, Director, BDR Pharmaceuticals, which is one of the manufacturers of anti-Covid-19 drug Molnupiravir.

“In very critical cases, more potent drugs like Tocilizumab were also administered for treatment and yielded positive results. Drug sales have spiked in the past two years, especially the critical care, OTC vitamins, and other antibiotics. The trend has continued, however, post-Covid as clinics have become more functional, and drug sales of derma and oncological injectables have also started to pick up,” says Shah.

Will the Momentum Sustain?

The Covid-19 pandemic threw open opportunities for some drugs, which at one point in time became difficult to procure such as Remdesvir and some steroid brands in the second wave, and Dolo, Zincovit and others in the third wave. As the pandemic has receded, the popularity and demand looks difficult to sustain. “Pandemics will never make a company rich, because pandemics come and go, so there could be opportunities for very few companies,” says Satyanarayana Chava, Founder & CEO, Laurus Labs, adding as an example that Dolo 650 became popular and almost a synonym for Paracetamol.

Jayaraj holds a view that a similar pattern will show up in future pandemics, too. “Drugs like Paracetamol, Azithromycin, Favipiravir, Doxycycline, Corticosteroids and immune boosters were recommended by Indian Council of Medical Research (ICMR) for the treatment of Covid and the leading brands in these segments gained immensely,” he says, adding that Dolo 650 being the leader in the Paracetamol market, garnered huge prescriptions and gained immense popularity.

True, but now we are back to the question: Can the momentum sustain? And the answer seems to be a clear ‘no’. Data from IQVIA shows that Dolo 650, Azithral and Calpol, which saw spike in sales in January due to the third wave of Covid-19, are no longer in the top 25 brands in February, in terms of sales. Instead, the top-selling drug brand in February was Mixtard, a drug used for managing diabetes, from Novo Nordisk, a Danish multinational pharmaceutical company. So, the Covid-19 opportunity for non-Covid-19 drugs seems to have come and gone, and is not likely to come back unless there is another wave. And that is something no one would wish for.

@neetu_csharma