According to an analysis of studies being published in the New England Journal of Medicine, Avandia from GlaxoSmithKline (NYSE:GSK), “significantly increases” the risk of heart attacks. The analysis also found increased risk of death from cardiovascular causes that “had borderline significance”. The analysis was conducted by Steven Nissen, a cardiologist at the Cleveland Clinic.

Not surprisingly in a press release Glaxo said they strongly disagreed with the conclusions of the article.

This is just the latest in a series of setbacks for Avandia. With Januvia from Merck (NYSE:MRK) continuing to gain market share, this latest news gives physicians one more reason to switch their patients from Avandia to Januvia. Although Januvia’s performance has been mixed Diabetic Investor has not yet discovered any serious adverse events associated with the drug.

Amylin (NASDAQ:AMLN) the makers of Byetta is another beneficiary of this news. As Diabetic Investor pointed out in a previous email alert, it is possible that a new paradigm is developing in the treatment of type 2 diabetes. Based on the lack of adverse events associated with Januvia, Diabetic Investor speculated that physicians would lower their usage of TZD’s like Avandia and increase their usage of Januvia and Byetta. Byetta has proven to be particularly effective with the added benefit of progressive weight loss. This latest news on Avandia reinforces our view that physicians will move towards a new therapy progression with metformin used as the front line therapy, followed with the addition of Januvia or now Janumet (Januvia and metformin in one pill) followed by Byetta.

Based on the mixed reviews Januvia is getting from physicians and patients Byetta usage should accelerate in the coming months. Now that Januvia has been on the market for over six months were beginning to see comparative results from patients using Januvia. There is no question when comparing results side by side Byetta is a far more effective drug than Januvia. As effective as Byetta has been there are some who see the fact that Byetta must be injected twice daily as an obstacle to greater adoption. Armed with the latest data on Avandia and Januvia’s less than impressive performance physicians are running out of effective options to treat type 2 diabetes other than Byetta or insulin. Given the many obstacles to insulin therapy, also an injectable drug, Byetta is looking better and better.

Diabetic Investor does not believe Januvia will go by the wayside, nor do we believe physicians will use Byetta as a frontline therapy. However, we see Byetta coming into the therapy regimen more quickly as other options fail to provide adequate control.

Interesting times ahead.

David Kliff
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