This integrated effort launched solely into the US market, which is highly regulated by the Office of Prescription Drug Promotion (OPDP), a division of the US Food and Drug Administration (FDA). In general, OPDP has the responsibility for reviewing prescription drug advertising and promotional labeling to ensure that the information contained in these promotional materials is not false or misleading to any audience. We ensured that promotion was in compliance with all OPDP rules and regulations, fair and balanced information was provided, and that all medical claims were substantiated. All branded Xifaxan promotion and unbranded HE-disease state promotion included in this campaign were subjected to rigorous medical, regulatory, and legal review from Salix Pharmaceuticals, Ltd.

Hepatic encephalopathy, also known as HE, is a complication of liver cirrhosis in which symptoms mimic bipolar disorder, Alzheimer’s disease, and schizophrenia. As a complication of cirrhosis, HE affects mostly former (or current) drug and/or alcohol abusers. While physicians were aware of this complication, the truth was that they just didn’t care. Physicians didn’t appreciate how significantly patients and their families were affected by this condition, so treating it was a low priority. Getting physicians to care about the devastating effects of HE and be proactive in its treatment were our challenges.

Demonstrating to physicians why they needed to be vigilant about treating HE was critical to this campaign. We created an unbranded documentary to raise awareness about the devastating effects of HE. Working with Academy Award–winning director Cynthia Wade, Wrestling the Monster showed the heartbreak of life with HE. The branded effort for Xifaxan 550 mg focused on the vulnerability of the HE patient and came to life through personal and nonpersonal channels.

Prior to this campaign, only 35% of physicians truly understood the plight of HE patients. That number is now at 75%. Prescriptions for Xifaxan 550 mg have increased by 35%.

Patients with cirrhosis have many complications. HE is only one of them. Our goal was to get US hepatologists, gastroenterologists, and primary care physicians to care enough about HE so they would become more vigilant about treating it. To do this, we had to confront them with just how vulnerable these patients and their families are to the devastating effects of this condition. From both a branded and unbranded perspective, this campaign was designed to demonstrate that HE recurrence is unacceptable and preventable through continuous treatment.

Wrestling the Monster, the unbranded documentary chronicling 4 patients and families living with HE was created in collaboration with the American Liver Foundation and Academy Award–winning director Cynthia Wade. Wade was a natural choice because she specializes in telling untold stories from people who would not otherwise have a voice. The film reached physicians through a variety of channels, including convention materials, a microsite, and social media sharing by Salix, the American Liver Foundation, and individual physicians. Film premiere events featuring roundtable discussions with the director, a patient and caregiver, and other key members of the liver disease community took place at two major professional conventions.

The branded effort incorporated language familiar to physicians partnered with arresting and descriptive photography/CGI from Joan Garrigosa. It was launched across the US to the gastroenterology and hepatology communities through personal and nonpersonal tactics.

With so much attention being paid to HE both in the branded and unbranded space, physicians not only began to take notice, they also began to care. There have been more than 17,000 video views on the Wrestling the Monster microsite, and more than 1800 people have shared the film on Facebook. One Healthcare Professional who attended the premiere event had this to say about the film:

“I think it’s an amazing film, a very powerful film that truly puts a human face on an under-recognized disease.”

Prior to this integrated campaign, approximately 35% of gastroenterologists truly understood the plight of patients with HE. That number has now risen to approximately 75%. And most important, HE patients were finally getting the treatment and the care they so desperately needed—prescriptions for Xifaxan have increased by 35%.

Showing the real plight of patients and their families was integral in overcoming physician apathy toward treating HE. Therefore, the patient experience played a large role in both the unbranded and branded parts of this campaign. The unbranded effort was designed to show physicians what they don’t see: what really happens to patients once they leave the medical office. Because we needed to tell a story that hadn’t been told before, documentary film felt the most authentic and unexpected for this category. Once physicians understood just how devastating HE could be, a branded effort underscoring the need for continuous treatment with Xifaxan was a natural complement. Personal channels, including an iPad sales presentation, and non-personal channels, including a print ads and a website, reinforced the benefits of Xifaxan for the vulnerable HE patient across many touch points.

Hepatic encephalopathy, also known as HE, is a complication of liver cirrhosis in which symptoms mimic bipolar disorder, Alzheimer’s disease, and schizophrenia. As a complication of cirrhosis, HE affects mostly former (or current) drug and/or alcohol abusers. And while physicians are well aware of HE as a potential complication, they simply don’t care enough about it to be proactive in treating it. Because physicians don’t have a real appreciation for how devastating HE is, they treat HE reactively and episodically—and don’t think about it as a chronic condition. This approach leads to a vicious cycle of hospitalization, decline, and death.