SCHERING-PLOUGH CORP.

When Phyllis Segawa found out she had hepatitis C, her biggest fear was taking the prescribed medication. She was so frightened about the devastating side effects the drugs can have, she waited two years to begin taking them.

She finally found the courage through the support given her by nurses under contract with pharmaceutical company Schering-Plough Corp. to help sustain hepatitis C sufferers through their drug regimen. After three months of therapy, Segawa had experienced no side effects – though she works hard to prevent them.

“The nurses helped prepare me,” says Segawa, who lives on the Hawaiian island of Kauai, where she manages four national botanical gardens. “They sent me information, called to check on me and had a good, positive influence over me. I knew in order to get through this treatment, I had to have a positive attitude.”

Nursing support is the core component of Be in Charge, Schering-Plough’s direct marketing effort for the hepatitis drug program. Other aspects include a Web site, a newsletter mailed every other month and a binder packed with information, coping tips and referrals to support groups close to home, as well as a workbook to track diet and side effects.

The drugs, licensed by the Kenilworth, NJ company, are Intron A (injected three times a week) and Rebetol (a pill taken daily). Together they are called Rebetron combination therapy.

“If the patient is getting a response and goes off the drug due to side effects, then the bottom line is the drug isn’t working,” says Steve Taglienti, product director for Rebetron/Intron A-hepatitis. “So it’s important that they stay on therapy.”

The 14 nurses who call to monitor program participants’ progress can be reached for questions and counseling at a toll-free number during the workday. They give Schering-Plough its best shot at ensuring the medication does its job.

Company executives know the program works because only 2% of enrollees drop out as a result of the drugs’ side effects. This compares with a 15% dropout rate (tracked in outside clinical studies) of patients taking the drugs who are not in the program. Nearly 9,000 have signed on since the program launched in 1997.

“From a marketing perspective, the longer they stay on therapy, the better sustained are response rates,” says Jane Ranigan, sales training manager for the hepatitis program. Therapy length and effectiveness varies for each patient.

For all its humanitarian successes, Be in Charge is a centerpiece of Schering-Plough’s bottom line. Second only to its antihistamine Claritin in revenue, combined sales of Intron A alone and Rebetron combination therapy increased 50% to $347 million in 1998.

Hepatitis C is a liver disease transmitted by blood. Most of the 4 million Americans with the disease became infected through tainted blood transfusions during surgery, some of them as long as 30 years ago. One of the nastier aspects of this “silent epidemic” is that an individual may have the disease but will experience no symptoms for long stretches.

Since 1992, when a test was developed to locate the virus in the blood supply, transmission has been found to occur mostly when infected needles are shared among users of illicit drugs. Though not everyone is a good candidate for the combination therapy, those who are not treated are at risk for developing fatal illnesses such as liver cancer and cirrhosis.

Side effects mimic a bad case of the flu – plaguing patients with headache, fatigue and fever. Others experience depression or feelings of isolation. Patients can limit their side effects, but it takes commitment.

Nurses advise people to drink a lot of fluids, force themselves to eat a balanced diet, get plenty of sleep and actively seek support. Since most hepatitis C victims work and lead normal lives as they battle their chronic illness, keeping the side effects at bay can seem overwhelming.

For Segawa, who needed encouragement, and for others who struggle with depression or being ostracized because of misunderstandings about how the disease is contracted, the nurses’ emotional support is priceless.

“Probably the most common thing I hear is that it was so important for them to have a nurse to talk to because we understood and cared when no one else did,” says Kathy Churchill, nurse manager of Be in Charge.