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XENETIX AND COMPETITORS

VISIPAQUE
ACTIVE INGREDIENT Iodixanol - Nycomed ( Norway) CHEMICAL STRUCTURE
OH OH OH OH

CH2CHCH2NHCO

CONHCH2CHCH2

I
OH

I
CH3 CO

I
CH3 CO

I
OH

CH2CHCH2NHCO
OH

NOH2CHCH2N

CONHCH2CHCH2

OH

OH

VISIPAQUE
PHYSICO-CHEMICAL FEATURES
Pr p r ti I dix I dix I dix l 150 l 270 l 20 Os l lit ( Os /kg t r) 290 290 290 Vis sit ( P .s) t 7C 1.7 5.8 11.4

VISIPAQUE
PROCEDURES
Indication
Com uted tomo ra hy (head - whole body) Cerebral IA DSA Peri heral IA DSA Peri heral arterio ra hy IVU Phlebo ra hy Cardiac an io ra hy

Iodixanol 150

Iodixanol 2 0

Iodixanol 320

     

 

VISIPAQUE
PRESENTATIONS
20 ml Vi i aque 150 Vi i aque 2 0 Vi i aque 320 50 ml 5 ml 100 ml 200 ml

       

  

VISIPAQUE
ARGUMENTATION
An i otonic olution rovide comfort for the atient durin the examination (by reducin ain and heat) and ecurity of examination for theradiolo i t (more reliable dia no i becau e of o timal contra t due to a reduction of artefact related to atient movement ) The addition of Na+ and Ca++ tabili e hy iolo ical function , e ecially cardiac, leadin to a decrea ed ri of arrythmia and ventricular fibrillation

VISIPAQUE
COUNTER-ARGUMENTATION
Li e any non-ionic dimer, Vi i aque i very vi cou and it tran it time in the microcirculation i therefore rolon ed, leadin to a ri of va cular i chaemia and rolon ation of the endothelium contact time. Due to it i o-o molality, there i no o motic diure i henomenon; the contact time with renal cell i increa ed, with a con equently increa ed ri of renal toxicity.

VISIPAQUE
COUNTER-ARGUMENTATION (continued)
The combination of i o-o molality/hi h vi co ity al o increa e the vi co ity of the urine and cau e re i tance to urine flow in the di tal convoluted tubule. Due to the hi h vi co ity of Vi i aque, manual injection are more difficult and require reheatin of the roduct, leadin to ractical limitation in certain indication

OMNIPAQUE
ACTIVE INGREDIENT Iohexol - Nycomed ( Norway) CHEMICAL STRUCTURE
CONHCH2CHOHCH2OH

I
CH3OC
N

CONHCH2CHOHCH2OH

CH2 CHOH CH2OH

OMNIPAQUE
PHYSICO-CHEMICAL FEATURES
Pre aration Iohexol 240 Iohexol 300 Iohexol 350 O molality (mO m/ water) 520 690 820 Vi co ity (mPa. ) at 3 C 3.2 5. 10.5

OMNIPAQUE
PHYSICO-CHEMICAL FEATURES
Pre aration Iohexol 240 Iohexol 300 Iohexol 350 O molality (mO m/ water) 520 690 820 Vi co ity (mPa. ) at 3 C 3.2 5. 10.5

OMNIPAQUE
PROCEDURES
Indication
Uro ra hy Arterio ra hy Phlebo ra hy An iocardio ra hy DSA (ia) DSA (iv) Arthro ra hy

Iohexol 240

Iohexol 300

Iohexol 350

   

 

 

 

OMNIPAQUE
PRESENTATIONS

10ml Iohexol 240 Iohexol 300 Iohexol 350

20ml

50ml

5ml

100ml 200ml 500ml

         

OMNIPAQUE
ARGUMENTATION
The Ba ed on Nycomed fame with it worldwide old iohexol. Due Key oint : hi h level of hydro hilicity low rotein-bindin rate Sim le USP Believe in ex erience Nycomed well- nown for it hi h level of ervice olicy

OMNIPAQUE
COUNTER-ARGUMENTATION

Elimination half-life hi her com ared to Xenetix (2-3 hr v 1.8 hr) Preclinical tudie favourable to Xenetix ( idney - neurolo y)

IOPAMIRON
ACTIVE INGREDIENT Io amidol - Bracco (Italy) CHEMICAL STRUCTURE
CH2OH CONHCH

CH2OH

CH2OH CH3CHCOHN OH CONHCH

CH2OH

IOPAMIRON
PHYSICO-CHEMICAL FEATURES
Pre aration Io amidol 200 Io amidol 250 Io amidol 300 Io amidol 3 0 O molality (mO m/ water) 413 515 616 99 Vi co ity (mPa. ) at 3 C 2.0 3.0 4.5 9.5

IOPAMIRON
PROCEDURES
Indications Arterio ra hy An iocardio ra hy CT IVU DSA (iv, ia) Myelo ra hy Phlebo ra hy Radiculo ra hy Io a idol Io a idol Io a idol Io a idol 7

          

 

IOPAMIRON
PRESENTATIONS
5 l 1 l 2 l l 5 l 75 l 1 l 2 l 5 l

I p 2 I p 25 I p I p
7

i i i i

l l l l

      

         

IOPAMIRON
ARGUMENTATION
Confidence throu h ex erience. More than 2500 cientific ublication ince 1980 confirm the hi h afety level of the com ound. Very low neurotoxicity level: hi h LD50 Authorization for u e in children and myelo ra hy confirm ood afety rofile

IOPAMIRON
COUNTER-ARGUMENTATION
Not an o timal ICM: io amidol 3 0 may cry tallize (indicated in the atient information leaflet) Io amidol com ri e only five OH radical lower hydro hilicity com ared to Xenetix Elimination half-life: 2 hour (more than Xenetix)

IOPAMIRON

COUNTER-ARGUMENTATION (continued)

Ima e of an old fa hioned ICM with the launch of Iomeron No articular cu tomer-oriented ervice 500 ml i only available in the 300 concentration

ULTRAVIST
ACTIVE INGREDIENT Io romid - Scherin (Germany) CHEMICAL STRUCTURE
CH3 CONCH2CHOHCH2OH

CH2COHN O CH3

CONHCH2CHOHCH2OH

ULTRAVIST
PHYSICO-CHEMICAL FEATURES
Pr p r ti I pr I pr I pr I pr i 1 i 24 i i 7 Os l lit ( Os /kg t r) 4 48 61 77 Vis sit ( P .s) t 7C 1. 2.8 4.6 .

ULTRAVIST
PROCEDURES
Indication An iocardio ra hy An io ra hy Peri heric an io ra hy Arterio ra hy Phlebo ra hy Io romid 150 Io romid 240 Io romid 300 Io romid 3 0

     

ULTRAVIST
PRESENTATIONS
5ml 10ml 20ml 30ml 50ml 5ml 100ml 150ml 200ml 500ml

Io romid 150 Io romid 240 Io romid 300 Io romid 3 0

              

ULTRAVIST
ARGUMENTATION
Communication olicy ba ed on Scherin com any fame. Io romid i available till the middle of the 80 : ex lained by the USP proven is proven Po itionin accordin mainly to ima e quality and tolerance in the main indication (ia and iv) All communication i focu ed on the core of io romid ( hy icochemical feature , o molality, vi co ity) but neither on the environment of it

ULTRAVIST
ARGUMENTATION (continued)
Tolerance in cardiolo y mainly ex lained by low o molality Low rotein-bindin -rate i the unique documented feature Active o itionin of the ran e i io romid 3 0 in cardiolo y, io romid 300 in DSA and CT and io romid 240 in hlebo ra hy

ULTRAVIST
COUNTER-ARGUMENTATION
Not Io romid hy icochemical feature are not o timal: very oor hydro hilicity (four OH only) very hi h level for cro in the lacenta: 5-10% (<0.1% for Xenetix) Therefore, no quantitative data available re ardin the half-life elimination

ULTRAVIST
COUNTER-ARGUMENTATION (continued)

Potential adver e event hi her for Io romid, althou h no clinical data available today for confirmin thi oint Main advanta e for Xenetix: ervice olicy around the roduct

IOMERON
ACTIVE INGREDIENT Iome rol - Bracco (Italy) CHEMICAL STRUCTURE
OH CONHCH2CHCH2OH

I
HOCH2CO N CH3

CONHCH2CHCH2OH

OH

IOMERON
PHYSICO-CHEMICAL FEATURES
Pre aration Iome rol 150 Iome rol 250 Iome rol 300 Iome rol 350 Iome rol 400 O molality (mO m/ water) 301 435 521 618 26 Vi co ity (mPa. ) at 3 C 1.4 2.9 4.5 .5 12.6

IOMERON
PROCEDURES
Iome rol 150 Iome rol 250 Iome rol 300 Iome rol 350 Iome rol 400

Indication IV uro ra hy Infu ion uro ra hy Phlebo ra hy DSA hlebo rahy CT head

     

IOMERON
PROCEDURES (continued)
Indication CT total body An io ra hy Cerebral IA DSA Thorax Abdomen An iocardio ra hy Iome rol 150 Iome rol 250 Iome rol 300 Iome rol 350 Iome rol 400

   

  

 

   

IOMERON
PRESENTATIONS
10ml Iome rol 150 Iome rol 250 Iome rol 300 Iome rol 350 Iome rol 400 30ml 50ml 5ml 100ml 200ml 500ml

       

    

    

IOMERON
ARGUMENTATION
Lowe t vi co ity amon all non-ionic available today with followin advanta e : ea y handlin when fillin the yrin e ea ier injection in ti ht catheter Lowe t o molality amon all non-ionic available today for: im roved tolerance im roved ima in due to reduced movin artefact

IOMERON
ARGUMENTATION (continued)

Hi h Iome rol chemical tability allow not to u e the EDTA tabilizator Hi h Iome rol hydro hilicity allow a hi h concentrated roduct: 400 m I/ml

IOMERON
COUNTER-ARGUMENTATION
For every contra t a ent, there i a clo e relation hi between o molality, vi co ity and hydro hilicity Iome rol o e e the lowe t o molality and vi co ity, but di lay a very oor hydro hilicity (octanol/water artition coefficient) Quantitatively confirmed (only five OH rou )

IOMERON
COUNTER-ARGUMENTATION (continued)
What i the intere t in very low feature if counterbalanced by uch a chimiotoxicity? Iome rol o e e the ame chemical formula a Io amidol: cry tallization ri are well- nown for Io amidol 3 0. What about Iome rol 400? Today, the trend i to reduce the concentration u ed

IOMERON
COUNTER-ARGUMENTATION (continued)
Iome rol ha a oor olubility (126% v 140% for Xenetix) The ab ence of tabilizator i not due to the roduct tability. EDTA bind to cu fer element which are mainly due to the roduction roce (involvin metallic material ). Since Iome rol i roduced in non-metallic material, thi ri doe not exi t Durin clinical trial for re i tration, Iome rol ha only be com ared to diatrizoate and Io amiron (non com ari on with Omni aque)

IVEPAQUE
ACTIVE INGREDIENT Io entol - Nycomed (Norway) CHEMICAL STRUCTURE
C NHCH CH H CH H

I
H CH CH3 HCCH N =C CH3

C NHCH CH H

CH

IVEPAQUE

PHYSICO-CHEMICAL FEATURES
Pr parati I p I p I p I p I p t l t l t l t l t l 64 4 O m lality (mO m/ wat r) Vi c ity (mPa. ) at C . . .9 6. .

IVEPAQUE
PROCEDURES

Indication Arterio ra hy An iocardio ra hy CT

Io entol 150

Io entol 200

Io entol 250

Io entol 300

Io entol 350

   

IVEPAQUE
PRESENTATIONS
20ml Io entol 150 Io entol 200 Io entol 250 Io entol 300 Io entol 350 50ml 50ml
(US ac )

5ml

100ml 1 5ml 200ml

          

  

IVEPAQUE
ARGUMENTATION
2 main ar ument develo ed by Nycomed re ardin : PHYSICOCHEMICAL FEATURES: im roved endothelium afety ood renal afety no effect on blood-brain-barrier CUSTOMERCUSTOMER-ORIENTED SERVICE unique oft ac Nycomed In Out y tem (recyclin y tem)

IVEPAQUE
COUNTER-ARGUMENTATION
Io entol re re ent the wor t com romi e re ardin hy icochemical feature of all non-ionic com ound available today: hi h vi co ity, avera e o molality and oor hydro hilicity Renal afety rofile i only mea ured by the enzyme elimination althou h it i well- nown that thi mea urement i not clinically relevant. Today, the old tandard i creatininemia (a with Xenetix)

IVEPAQUE
COUNTER-ARGUMENTATION (continued)
Io entol doe not exi t in 500 ml re entation The unique oft ac i available for 50 ml re entation: feedbac from the field re ort that the o enin remain inconvenient With Iodixanol, Iohexol and Io entol, Nycomed ha at lea t 3 roduct on the mar et. With re ard to it o itionin , thi matter of fact doe not erve to tren then the Com any me a e

OPTIRAY
ACTIVE INGREDIENT Iover ol - Mallinc rodt (USA) CHEMICAL STRUCTURE
OH CONHCH2CHCH2OH

I
HOCH2CO
N

I
OH CONHCH2CHCH2OH

HOCH2CH2

OPTIRAY
PHYSICO-CHEMICAL FEATURES
Pr I I I I I arati n Osm lality (mOsm/ wat r) Visc sity (mPa.s) at 7C 1.6 .1 6 71 7 . 6.1 .

rs l 16 rs l 24 rs l rs l 2 rs l

OPTIRAY
PROCEDURES
In ications Arterio ra hy Aorto ra hy Coronaro ra hy CT DSA IVU Phlebo ra hy Ventriculo ra hy Io ersol Io ersol Io ersol Io ersol Io ersol

 

           

OPTIRAY
PRESENTATIONS
10ml 20ml 30ml 50ml 5ml 100ml 125ml 150ml 200ml 500ml

Iover ol 160 Iover ol 240 Iover ol 300

 PFS     PFS  PSF/


IPFS


 
IPFS


IPFS

 

Iover ol 320

 PSF/
IPFS


IPFS

Iover ol 350

 IPFS


IPFS


IPFS

OPTIRAY
ARGUMENTATION

Clo e relation hi between hydro hilicity and overall afety (tolerance, comfort) Iover ol com ri e ix OH radical and i mar eted accordin to the balanced hydro hilicity conce t

OPTIRAY
ARGUMENTATION (continued)

PFS in order to: cut down examination co t allow ea ier handlin minimize ri of mi under tandin the roduct Mallin crodt ell CT injector and i able to ro o e a lobal a roach to it cu tomer

OPTIRAY
COUNTER-ARGUMENTATION
With the conce t of tabilized hydro hilicity, Xenetix i one te forward Thi i confirmed by an im roved olubility (140% for Xenetix, 120% for O tiray) and the elimination halflife (1.8 hr for Xenetix, 2.06 for O tiray) Thi feature i very im ortant for renal afety, e ecially for atient at ri . With Xenetix, contact time with celle i horter than with Iover ol

OPTIRAY
COUNTER-ARGUMENTATION (continued)
Poor do e-ran e, PFS not nece arily well ada ted to CT indication ince more than 120 ml i often needed for thi ty e of examination Le flexibility if a econd hot i nece ary Xenetix rovide the ri ht olution for the ri of mi ta e with fla label a well a additional batch number and ex iry date information Xenetix i available in 500ml re entation at 3 concentration

XENETIX
ACTIVE INGREDIENT Iobitridol - Guerbet (France) CHEMICAL STRUCTURE

O NH-C-CH

CH2OH-CHOH-CH2-N-CO CH3

CO-N-CH2-CHOH-CH2OH

CH3

XENETIX
PHYSICO-CHEMICAL FEATURES
Pre aration Iobitridol 250 Iobitridol 300 Iobitridol 350 O molality (mO m/ water) 585 695 915 Vi co ity (mPa. ) at 3 C 4 6 10

XENETIX
PROCEDURES
Indication CT : - cranial - whole body DSA (iv) DSA (ia) Iobitridol 250 Iobitridol 300 Iobitridol 350

   

  

XENETIX
PROCEDURES (continued)
Indication Uro ra hy CT che t Arterio ra hy - cerebral - eri heral Iobitridol 250 Iobitridol 300 Iobitridol 350

 

 

XENETIX
PRESENTATIONS
20ml Iobitridol 250 Iobitridol 300 Iobitridol 350 50ml 60ml* 5ml* 100ml 200ml 500ml*

 

  

   

  

  

  

* according to the country

XENETIX
ARGUMENTATION
Xenetix i the achievement of an ori inal chemical conce t: the tabilized hydro hilicity The hi he t hydro hilicity rofile amon all roduct mar eted today (o motic coefficient w) The mo t balanced com romi e, benefit for the atient/advanta e for the radiolo i t Si nificative tolerance advanta e roved on reclinical tudie (renal afety - neurolo ical afety) in com ari on with Omni aque

XENETIX
ARGUMENTATION (continued)

The quic e t elimination half-life (1.8h)

Im ortant added value to the cu tomer with ervice olicy a ociated with Xenetix (fla label, fillin it, 500 ml re entation in all concentration )

XENETIX
COUNTER-ARGUMENTATION

No clinical i nificative advanta e com ared to nonionic already available No myelo ra hy, which in non o en minded radiolo i t , could mean lower neurolo ical afety