Januvia Update – A Mixed Bag

Januvia Update – A Mixed Bag

Is it possible for a drug that appears to be on its way to blockbuster status really doesn’t work that well? That’s the picture that’s emerging from patient and physician interviews conducted by Diabetic Investor regarding Merck’s (NYSE:MRK) new diabetes drug Januvia.

Looking at the numbers alone it would appear that Januvia is well on its way to achieving blockbuster status. According to the most recent prescription data Januvia now accounts for nearly 10% of all new prescriptions in the diabetes category. Partly due to Januvia Merck has raised their full year earnings guidance and with the recent approval of Janumet, a combination of Januvia and metformin into one pill, many analysts are raising their sales forecasts for the Januvia franchise.

However based on our interviews Diabetic Investor isn’t quite ready to crown Januvia as the new champion. Although we have not discovered any serious adverse events, patient interviews did reveal that the drug is hardly event free. More revealing was the performance or should we say lack thereof. While there are a number of patients and physicians who are seeing adequate control there is an equal number who have not seen any improvement. Also revealing was the number of patients who have stopped using Januvia.

Still physicians, in particular primary care physicians, continue to prescribe Januvia for their Type 2 patients. Diabetes specialists on the other hand have become more selective with Januvia and are quicker to pull a patient off the drug. This is hardly surprising as primary care providers tend to follow the treat to failure approach before moving patients onto other treatment regimens. Given the lack of serious side effects it appears these primary care providers are willing to accept inferior control as they believe patients will be more compliant when on Januvia – put another away it’s better to have a patient taking their medication even when it doesn’t work that well then to have them not taking any medication at all.

For those who believe that Januvia is hurting Byetta sales there is little evidence to support this claim. Both primary care and diabetes specialists understand the differences between the two drugs and some have even used the two drugs together. As Diabetic Investor suspected physicians are quicker to prescribe Byetta with their obese patients due to Byetta’s proven ability at helping patients lose weight. In spite of what Merck sales rep are saying out in the field Januvia does not help patients lose weight. And when compared side by side Byetta patients are achieving superior control compared to those on Januvia.

The bottom line here is it’s still a bite premature to state that Januvia is the next diabetes drug to reach blockbuster status. There is no question that drug is off to strong start and Merck is doing an excellent job at marketing Januvia. However with the high number of non-responders it will be interesting to see where the drug is six months from now. Diabetic Investor believes as more data becomes circulated through the physician community Januvia prescriptions will slow and start to level off. This does not mean the drug will not be commercially successful rather it could become just one of many drugs physicians have in their arsenal when it comes to treating Type 2 diabetes.

David Kliff
Diabetic Investor
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