Is the GLP-1 market finally coming into its own?
One of the few bright spots of this morning AstraZeneca (NYSE:AZN) earnings call was the improving performance of their once-weekly GLP-1 Bydureon which is now available in a patient friendly pen delivery device. This news follows very positive comments made by Lilly (NYSE:LLY) yesterday regarding their once-weekly GLP-1 Trulicity. GlaxoSmithKline (NYSE:GSK) also has a once-weekly GLP-1 Tanzeum but will not report earnings until May 6th.
Regardless of how Tanzeum is doing it’s becoming clear that GLP-1 market is finally coming into its own. Now that we have three once-weekly GLP-1’s, all of which come with a patient friendly pen delivery device, physicians are increasingly turning to these products rather than insulin for patients who are failing on oral therapies alone.
As we have noted since these products hit the market GLP-1’s offering several compelling benefits over insulin. Besides offering good glycemic control, GLP-1’s offer the additional benefit of weight loss, simple dosing and little risk of hypoglycemia.
This greater adoption of GLP-1 therapy should also send a message to anyone who’s watching sales of Afrezza. Although two different products both Afrezza and GLP-1’s are targeted at patients with Type 2 diabetes who are currently failing to control their diabetes. Both are add-on therapy options to a patients existing therapy regimen.
Now let’s take a look at the differences between the two, while Afrezza requires a patient to monitor their glucose levels GLP-1’s do not. While Afrezza comes in multiple dosing options, GLP-1’s come with one dosing option. Afrezza is used multiple times each day while GLP-1’s are administered just once a week. Afrezza has poor formulary position, GLP-1’s have favorable formulary position. Physician have years of patient experience with GLP-1 therapy, Afrezza is an unknown commodity.
Now this does not mean a GLP-1 is always a better choice than Afrezza or that both therapies cannot coexist. Yet in today’s marketplace physicians and payors hold the keys to the kingdom and right now market dynamics favor GLP-1’s over Afrezza. This is another reason Diabetic Investor remains convinced that Afrezza will be nothing more than a niche product and not the blockbuster some believe it will come. Besides battling two dominate well known short-acting insulin’s, the drug must also battle against three once-weekly GLP-1’s.
There is also another lesson to be learned here, as it took years for this market to develop. The benefits of GLP-1 therapy we outlined earlier have always been present. Yet it wasn’t until physicians and payors became comfortable with these drugs did the market develop. Now it is possible that the Afrezza market will develop over time however the drug may not be given the time it needs to develop, that Sanofi (NYSE:SNY) will decide they can no longer afford to wait.
The harsh reality is physicians now have multiple options for their Type 2 patients who need an add-on therapy. That it is no longer a straight line from orals to insulin, insulin does not have to be the first add-on. This places a heavy burden on any new drug that’s targeted at Type 2 patients. With so many options available physicians tend to prefer options with broad formulary coverage. Drugs that have years of patient usage behind them. This doesn’t mean that new drugs like Afrezza can’t succeed, it just means it’s a very crowded and complex market dynamic.
That to succeed in this crowded and complex market it takes time to build trust. It takes time for physicians and payors to become comfortable with any new drug no matter how good it may look. What we’re seeing with the growing usage of GLP-1 therapy is just another example of this. This category has paid it dues and is now ready to move to the next level.
