Januvia and Byetta – Why they can co-exist and both prosper

Januvia and Byetta – Why they can co-exist and both prosper

Even before Januvia, Merck’s (NYSE: MRK) DPPIV, came to market many on the Street believed the drug would adversely impact sales of Byetta from Amylin (NASDAQ:AMLN). The general consensus was since both drugs were targeted at poorly controlled type 2 patients, primary care physicians who treat over 80% of patients with diabetes, would choose Januvia which is taken orally over Byetta which is injected.

A great deal was made of the fact that Merck sales reps were calling Januvia “Oral Byetta”. A rather strange claim since Januvia is weight neutral and patients on Byetta have seen progressive weight loss. It is also well known that Byetta produces better outcomes than Januvia. This is not to say that Januvia is an inferior drug, quite the contrary. When used in combination with metformin patients see solid results and do so with fewer side effects than patients using a TZD. For this reason Diabetic Investor has maintained that Januvia was a greater threat to Avandia from GlaxoSmithKline (NYSE:GSK) or Actos marketed by Lilly (NYSE:LLY). Diabetic Investor reasoned that physicians would be more adapt to choose Januvia over Avandia or Actos as both drugs have well known side effects.

Based on recent prescription data and corporate conference calls some interesting trends are emerging.

1. 1. Januvia and Byetta can co-exist and prosper as physicians are prescribing both drugs to specific patient populations. Because of Byetta’s proven ability to promote weight loss physicians will choose Byetta for their obese patients while preferring Januvia for non-obese or slightly obese patients.
2. 2. Reports of TZD’s demise, at this point, have been greatly exaggerated. Although Januvia produces comparable results with fewer side effects it is still an unknown commodity compared to TZD’s whose side effect profile is well known. Put another way, the physician is comfortable with TZD’s and is still learning about Januvia.
3. 3. The treatment to failure approach favored by primary care providers. Unlike an endocrinologist who monitors their patients more closely and is more adapt to change a patients therapy regimen at the first sign of failure. Primary care physicians do not see their patients as frequently and have tendency to stick with a therapy regimen for longer periods of time.

The real truth here is that with the exploding patient population and many treatment options there is room for all players. Diabetes is not your typical chronic disease where one therapy works for the majority of patients. This is where the Street is miscalculating. Today a physician can choose from nine different medications to treat diabetes. Factor in the growing popularity of combination therapy and it’s easy to understand why so many physicians are hopeful and confused at the same time. Add in the fact that primary care physicians lack the time to stay on top of all these new therapies and it’s becomes easy to understand therapy inertia. Finally it does not help matters any that no two patients with diabetes react the same way to certain drugs. As strange as it may seem Diabetic Investor has spoken with physicians who have taken a patient off Avandia put them on Actos only to see Actos work were Avandia failed – and these are two drugs from the class. These same physicians admit that finding the correct therapy regimen for their patients is more trail and error than exact science.

The bottom line when it comes to picking a winner here is that no one therapy option will dominate. Januvia, Byetta, Avandia and Actos can co-exist and even help each other. With the global epidemic growth rate of diabetes it should surprise no one if all of these drugs reach blockbuster status.

David Kliff
Diabetic Investor
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