Things are heating up for control of the Type 2 market

Things are heating up for control of the Type 2 market

This morning Decision Resources, a research firm focusing on pharmaceutical and healthcare issues, released a report entitled “Type 2 Diabetes: Blockbuster-Bound Januvia Addresses Physicians’ Concerns Over Hypoglycemia”. According to a press release issued by the company “a weight neutral oral antidiabetic drug would earn a 25 percent patient share in the treatment of type 2 diabetes”. The release goes on to state, “Given the prices set for each of the drug profiles and the size of the type 2 diabetic patient population in 2011, a 25 percent patient share would result in sales of $4.1 billion for an agent fitting the report’s Minimal Acceptable drug profile and $8.1 billion for an agent fitting the report’s Major Achievement profile.”

The report also states that Liraglutide from Novo Nordisk (NYSE:NVO) will become the “gold standard” for treatment of type 2 diabetes by 2011.

Diabetic Investor does not know the good people at Decision Resources but we must respectfully disagree with their conclusions. As we mentioned during our coverage of the ADA conference we do see a place for Liraglutide in the marketplace, however the long-acting once a week version of Byetta (Byetta LAR) from Amylin (NASDAQ:AMLN) has the potential to become a paradigm shifting drug for the treatment of type 2 diabetes.

It’s interesting that today when the FDA begins discussing how drugs for type 2 diabetes will be approved in the future this news hits the wire. It’s also interesting that the title of the press release is “A Weight Neutral Antidiabetic Drug Would Earn a 25 percent Patient Share in the Type 2 Diabetes Drug Market.” Just how one could conclude that Januvia from Merck (NYSE:MRK) or Liraglutide has more potential than Byetta LAR is a mystery to Diabetic Investor. This is especially true when all the available data is put side by side. Take a look at the facts and decide for yourself.

A. All GLP-1’s and it doesn’t matter which GLP-1 you look at, have demonstrated they can effectively lower HbA1c.
B. All GLP-1’s have demonstrated that nausea is the primary adverse event for patients using the drug.
C. Diabetic Investor is not aware of any respected endocrinologist or diabetologist that sees Januvia as a particularly effective therapy option. It’s no accident that privately many have nicknamed the drug “Junknuvia”.
D. Weight Loss, not weight neutrality, has been demonstrated with all GLP-1’s.

Januvia’s strongest selling point is that it’s an oral not an injectable. Try as they might Merck cannot claim superior performance or lack of adverse events. The drug has already experienced one label change and reports are beginning to surface of other adverse events. Januvia is weight neutral at best and the majority of A1c lowering only comes when metformin is used in combination with Januvia. Take away metformin and Januvia has lackluster results and that is being overly kind.

Comparing Byetta LAR and Liraglutide is like comparing a MiniMed 508 insulin pump to their new state of the art Paradigm 722, both are effective but patients using state of the art technology have more tools available to help them more effectively manage their diabetes. LAR has with the added advantage of simple dosing, unlike Liraglutide which is injected once daily , LAR is injected just once weekly. Based on all available data LAR has a more robust weight loss result than Liraglutide. Finally it should be noted that Liraglutide isn’t even on the market yet.

Diabetic Investor isn’t sure which physicians Decision Resources interviewed for their report but they must be living on another planet. As we have stated on multiple occasions, the physicians interviewed by Diabetic Investor, whether they were diabetes specialists or primary care, see LAR as the clear preference and are anxious for the drug to become available. Like Diabetic Investor when all the data is reviewed physicians see LAR’s once-a-week administration for what it is, SIMPLE FOR THE PATIENT TO UNDERSTAND AND THE PHYSICIAN TO EXPLAIN.

When it comes to LAR the academics, PhD’s and intellectuals just can’t bring themselves to accept that patients and physicians prefer simplicity. For reasons only they seem to understand they prefer things to be more complex. (These are the same people who believed patients would use Exubera just because patients did not have to inject.) Diabetic Investor isn’t sure why they like things to be complicated but they do. Out in the real world where people actually work for a living and have other concerns beyond their diabetes, the simpler the better. Or as Ross Perot used to say “It’s just that simple.”

David Kliff
Diabetic Investor
847-634-4646 fax
224-715-3761 mobile