All this fuss over 0.2%
When it comes to selling pharmaceuticals, sales reps whose lives are dependent on these drugs for their incomes will use any piece of information to gain an edge on their competition. It really doesn’t matter if this information has any real value; it only matters if this perceived advantage convinces the physician to prescribe the drug. This is one reason sales reps for Novo Nordisk (NYSE:NVO) are giddy over the results of the Duration 6 study that compared Amylin’s (NASDAQ:AMLN) once-weekly GLP-1 Bydureon to their once-daily GLP-1 Victoza. A study conducted by Amylin that showed that at its highest dose Victoza lowered HbA1c by 1.5% while Bydureon only lowered HbA1c by 1.3%.
This 0.2% is not just ammo for Novo sales reps; it is also becoming ammo for Amylin naysayers in the investment community. Just as Novo reps are pointing to the results of Duration 6 as reason for physicians to prescribe Victoza over Bydureon, some analysts are also buying this argument believing this 0.2% performance difference is actually significant.
The funny thing about this entire argument is that Diabetic Investor is not aware of one physician who would select Victoza over Bydureon based on the results of Duration 6. Like most reasonable adults they will look at the body of clinical data, likely prescribe Bydureon to small group of patients, see how it goes and then either prescribe it more broadly or dump it. This is how things work in the real world.
Diabetic Investor also takes issues with the two other most heard arguments against Bydureon – needle size and mixing. Now to be honest a 25 gauge needle is not exactly milk and cookies but neither is it the size of nuclear missile. The reality here is this entire argument over needle size is a testament to just how far we have come with needle technology. It wasn’t that long ago that physicians and patients were thrilled when 25 gauge needles became available. Granted it’s not a 31 gauge micro-needle but it isn’t the obstacle Bydureon naysayers believe it is.
Next is the fact that unlike Victoza which comes in a very patient friendly pen delivery system, in its initial version Bydureon must be mixed prior to injection. Having seen the Bydureon patient kit and reading through the patient instructions two things are obvious, no this is not as easy as pen delivery nor is the obstacle the Bydureon naysayers believe it is. As Diabetic Investor has been stating from day one, initial Bydureon sales are merely the appetizer to the main course when the Bydureon pen comes along which will not only eliminate the need for mixing but also allow for a smaller needle.
What’s really behind all of these arguments against Bydureon is a general lack of knowledge about diabetes management and the true enemy – patient therapy compliance or should we say non-compliance. Frankly Diabetic Investor could care less what therapy option is prescribed as it doesn’t matter if the patient isn’t taking their meds when they are supposed to. Numerous studies have shown that it does not matter if the patient is taking pills or using an injectable, too many patients aren’t taking their meds when they are supposed to and this is a major reason why nearly two-thirds of all patients are not properly controlling their diabetes.
Physicians, primary care physicians in particular, (PCPs treat 80% of all patients with diabetes) understand this and live it every day. They realize that they can only do so much for their patients with diabetes and if they stand any chance at controlling their diabetes, they must take their meds. Yet day after day, they continue to see patients who are out of control who aren’t taking their meds as prescribed. Like a child who doesn’t want to do their homework, physicians have heard every excuse in the book as to why patients aren’t taking their meds.
But what’s more revealing is not what physicians know but how patients see things. Having talked with patients two things are obvious, these patients (even the ones just on pills) believe their therapy regimen is too complex and when asked would be thrilled if they only had to take their meds just once a week, an answer that does not change when they are told this therapy is injected or requires some patient interaction prior to injection. The general consensus among patients is that any drug that dumbs down their diabetes management to a once a week event is the drug they want to be on. (And we should mention these patients get very excited when they are told this once-weekly injection that requires their participation could help them lose a few pounds. Add weight loss into the mix and they could care less if the needle is the size of the Empire State building.)
So while everyone else is excited by 0.2% performance difference, the people who matter most- the physicians who prescribe drugs and the patients who take them – are focusing on the mundane yet very important real world usage of this new drug. We’ve said it before and we’ll say it again once-daily trumps twice-daily and once-weekly trumps once-daily and yes it that simple – which is probably why the Bydureon naysayers just don’t get it. They are so used to therapy options being not patient friendly they not sure what to make of one that is truly patient friendly.