5. How do they bucket???
Mild
Moderate
Severe
1st 3rd2nd
Nothing Diet/ LSC ASP
AS ASP++ TCA/ Z
AS++ ZELMAC
6. Live with it
Positive Natural
Treater
Open and Pro-Active
To better therapies
Highly
Bothered and dissatisfied
Socially Inhibited
/ low self esteem
life highly impacted by Syndrome
The Patient Spectrum…C-IBS Females
Doctor /
Rx Avoider
123
4
7. A-to-B Shift Strategy: IBS (Doctors)
Physician does not
recognize IBS as
a legitimate condition
Physician does not recognize
the IBS-C patient
Physician diagnoses IBS-C and treats
with diet/lifestyle and
single-symptom therapies
Physician uses Zelmac first-line for all
appropriate patients
STEP # 1
STEP # 2
STEP # 3
STEP # 4
Physician uses Zelmac in some,
not all, appropriate patients
Physician does not know how to
diagnose the IBS-C patient
Physician uses Zelmac in the
same way as he uses an
antispasmodic or laxative
STEP # 5
STEP # 6
8. Physician does not recognise IBS as a legitimate
condition
Summary of Issues, Barriers, and Hurdles
• Doctor is sceptical of legitimacy of IBS as a real
medical disorder
• Does not believe that he has many IBS patients in his
practice
• Does not understand underlying cause
• Does not believe that this condition has any impact
on the patient (her quality of life and daily activities)
as well as the community at large (cost implication)
Probing Questions
• What do you believe is the cause of IBS?
• How often do you prescribe antispasmodics or
laxatives to female patients?
• How often do you regularly treat female patients for
abdominal pain and/or constipation, yet the symptoms
always return?
• How often do you see patients with A,B or C?
• How often do you see patients with a combination of
these symptoms?
Key Zelmac Messages
• IBS is a prevalent condition in the community with
prevalence ranging from 10%-20%
• IBS is a chronic condition with serotonin playing a
major role
• IBS has a significantly negative effect on a patient’s
quality of life
• It is vital that the IBS sufferer be treated so that her
quality of life can be improved
Call Objective
Highlight that IBS is a prevalent and legitimate condition in the community & has more of an
impact on quality of life versus other chronic, episodic conditions
Suggested location in the
Zelmac Global A-B A B
Key Resources
Detail aid pages:
• Pg 3 - Impact of IBS showing prevalence, costs
and consultations
• Pg 4 – IBS impact on QoL versus other chronic,
episodic conditions (asthma and migraine)
• Page 5 – IBS impact on QoL
Trials:
• Hungin et al, Franke et al, Camilleri et al , Gershon et
al
9. Physician does not recognise the IBS-C patient
Summary of Issues, Barriers, and Hurdles
• Does not think of IBS-C when the patient complains
of individual symptoms of abdominal pain, bloating or
constipation
• Does not ask the correct questions to uncover her
history and cluster of symptoms
• The patient is uncomfortable and will not volunteer all
her symptoms unless the doctor asks her
Probing Questions
• Do you have patients who you see repeatedly and are
complaining of the same symptoms?
• Do you have patients who are using antispasmodics
and laxatives frequently?
• Do you have patients who have come to see you
because the abdominal pain has been unbearable?
• Do you have patients who complain that their bloating
is so bad that they battle to fit into their clothes?
• Do you have patients, who on further questioning,
admit that their symptoms are interfering with their
quality of life?
Key Zelmac Messages
• The IBS-C patient’s predominant symptoms are
abdominal pain, bloating and constipation
• She has a longstanding history of intermittent
episodes of symptoms
• Her symptoms impact on her QoL
Call Objective Enable the doctor to recognise the IBS-C patient
Suggested location in the
Zelmac Global A-B A B
Key Resources
Detail aid pages:
• Pg 1 – IBS-C patient profile
• Pg 2 – IBS-C patient profile
Trials:
• Hungin et all, Camilleri et al , IFFGD website, Chang
et al
10. Physician does not know how to diagnose the IBS-
C patient
Summary of Issues, Barriers, and Hurdles
• GP refers “query IBS-C” patients to a specialist
• Worries that he will misdiagnose organic disease
• Only gives a diagnosis of IBS-C after ruling out all
other diseases
• Does not know what questions to ask the patient
during the diagnosis
Probing Questions
• How do you currently establish a diagnosis of IBS-C?
• Do you perform exclusion tests?
• Do you refer patients who you suspect have IBS-C?
• What would be your reasons for referring?
• On further questioning, do you find that your patients
have more symptoms and concerns than what she
originally described?
Key Zelmac Messages
• Safe, confident, positive diagnosis through identifying
the predominant symptoms of abdominal pain with
constipation (ROME II criteria); probing to establish
what other symptoms the patient has and how long
she has had the symptoms, eliminating any red flags
Call Objective
Enable the doctor to diagnosis IBS-C by using the ROME II criteria to make a positive,
symptomatic diagnosis
Suggested location in the
Zelmac Global A-B A B
Key Resources
- ROME II diagnosis folder with the list of questions
-Detail aid pages:
• Pg 1 – IBS-C patient profile
• Pg 2 – IBS-C patient profile
• Pg 6 – IBS-C impact on QoL
-Trials:
Gershon et al, Hungin et al , Camilleri et al, Chang
et al
11. Physician diagnoses IBS-C and treats with
diet/lifestyle and traditional therapies
Summary of Issues, Barriers, and Hurdles
• Doctor is resistant to change and sees no need to
change
• Feels that his current approach is risk- free
• Does not perceive the patient’s unmet needs
• Does not understand the impact on the patient’s QoL
Probing Questions
• What treatment do you recommend to your IBS-C
patients?
• Do you follow up with these patients?
• To treat the multiple symptoms, do you prescribe
combination therapy?
• Do any of your IBS-C patients ever complain that their
symptoms get worse?
• Is there any reason you have not prescribed Zelmac?
Key Zelmac Messages
• Traditional therapies do not meet the need and only
treat individual symptoms
• Traditional therapies can exacerbate other symptoms
• Traditional therapies do not address the underlying
pathophysiology of IBS-C
• Traditional therapies do not provide global
multisymptom relief
Call Objective
Convince the doctor that traditional therapies do not address the underlying pathophysiology
of IBS-C and treat individual symptoms only, often exacerbating other symptoms
Suggested location in the
Zelmac Global A-B A B
Key Resources
Detail aid pages:
• Pg 7 – traditional therapies only treat individual
symptoms
• Pg 8– what would be the ideal IBS-C treatment?
Trials:
• Camilleri et al, Brandt et al, Novick et al, Corsetti, M
12. Physician uses Zelmac in the same way as he uses
an antispasmodic or laxative
Summary of Issues, Barriers, and Hurdles
• Doctor not convinced of the role of serotonin in
mediating GI motility, stool consistency, visceral
hypersensitivity
• Doctor wants to use Zelmac as PRN treatment to
provide symptomatic relief
Probing Questions
• How long do you Rx Zelmac for?
• Why would you Rx Zelmac for 7 days only?
• How do you describe how Zelmac differs from the
traditional therapies to your patients?
• How do you explain Zelmac dosing schedule to your
patients?
Key Zelmac Messages
• Zelmac MOA is different to that of the laxatives and
antispasmodics
• Zelmac is the only drug which mimics serotonin and
thus works in 3 ways to provide multi-symptom relief
(describe the 3 ways on page 10 in your detail aid) for
IBS-C
• Zelmac MOA provides rapid and sustained clinical
efficacy throughout the treatment period
Call Objective
Convince the doctor to use Zelmac for a full month and to completely differentiate Zelmac from
the traditional therapies
Suggested location in the
Zelmac Global A-B A B
Key Resources
Detail aid pages:
• Pg 8 – What would be the ideal IBS-C treatment?
• Pg 9 – First in a new class to address the
underlying cause of IBS-C
• Pg 10 – First in a new class to address the
underlying cause of IBS-C
• Pg 11 – Mutisymptom relief
• Pg 12 - Mutisymptom relief
• Trials:
• Hungin et al, Franke et al, Camilleri et al , Gershon et
al, Muller-Lissner et al, Brandt et al.
13. Physician uses Zelmac in some, but not all
appropriate patients
Summary of Issues, Barriers, and Hurdles
• Doctor perceives Zelmac to be for the more severe
IBS-C patients
• Doctor is reserving Zelmac for a number of reasons
(you would have to probe to establish the reason):
•Efficacy
•Cost
Probing Questions
• What would stop you from using Zelmac first line in
appropriate patients?
• What have your patients said about Zelmac?
• What differentiates Zelmac from other therapies you
have used?
• Why would you reserve Zelmac ?
Key Zelmac Messages
• Zelmac is the only drug that addresses the underlying
pathophysiology of IBS-C which needs to be
addressed in all IBS-C patients
• Traditional therapies only address one symptom and
may worsen others
• Zelmac has demonstrated efficacy and safety in
clinical trials where the patients had been
experiencing symptoms for various time periods
• Zelmac, as monotherapy has an advantage in terms
of convenience and efficacy
Call Objective Convince the doctor to use Zelmac first line for all IBS-C patients and not to reserve Zelmac
Suggested location in the
Zelmac Global A-B A B
Key Resources
Detail aid pages:
• Pg 9- First in a new class to address the
underlying cause of C-IBS
• Pg 10 – First in a new class to address the
underlying cause of C-IBS
• Pg 11, 12, 13, 14 – Multisymptom relief
• Trials:
Camilleri et al , Drossman et al, Muller-Lissner et al
Brandt et al, Lacy et al , Ringel et al, Kim et al.
