Revived potential for Activase

Now that the results of the GUSTO trial of Genentech Inc.'s Activase tissue plasminogen activator compared to streptokinase have been released, the big question is whether hospitals and physicians will change their use of Activase.

The worst-case scenario - of dramatically better SK results and plummeting tPA use - was dispelled by the data released on Friday. While analysts had ranked that as the least likely outcome, the downside risk to the company's earnings and its stock had caused some to move to the sidelines with "hold" ratings until the results were in.

GUSTO's investigators said the data, showing that Activase resulted in a 1 percent lowering of 30-day mortality compared to the study's SK arms, had "put to rest the battle of the thrombolytics." They said the findings were a clear endorsement of accelerated administration of Activase, for which the company is now seeking revised labeling.

Routes to more sales

With the drug showing benefits over SK, Genentech now has the opportunity to increase total sales. This can come about in three ways: it could take market share from SK; it could penetrate the population of patients eligible for thrombolytic therapy who are not now receiving it; or patients who are not now eligible to receive the drug could be considered eligible in future.