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Defeat Diabetes Foundation

Defeat Diabetes
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Januvia/Byetta Becoming First and Second-Line Therapy for Type 2 Diabetes

Posted: Wednesday, September 10, 2008

New research reports that Januvia is currently prescribed most often as a third- or later-line of therapy for the treatment of type 2 diabetes.

Surveyed endocrinologists and primary care physicians expect to shift their third- or later-line Januvia use to earlier lines of therapy in the next two years -- 44 percent and 48 percent of surveyed endocrinologists and primary care physicians, respectively, expect to increase their first-line prescriptions for Januvia and 35 percent and 33 percent of surveyed endocrinologists and primary care physicians, respectively, expect to increase their second-line use of Januvia between 2008 and 2010.

The PPAR-gamma agonists, Januvia and Amylin/Eli Lilly's Byetta are each competing for positioning in second- and third-line therapy because of the dominance of generic metformin and sulfonylureas in earlier lines of treatment. The new report entitled Treatment Algorithms in Type 2 Diabetes finds that since the May 2007 Nissen meta-analysis first publicized the cardiovascular risks of GlaxoSmithKline's PPAR-gamma agonist Avandia, physicians have reduced their use of the PPAR-gamma agonist drug class in second-line treatment. From January 1, 2005 to June 30, 2006, PPAR-gamma agonists captured 32.3 percent of second-line patient share, but between April 1, 2006 and September 30, 2007 their patient share in this line of therapy fell to 23.4 percent. These dynamics reflect not only a decline in Avandia's second-line patient share but also a lack of growth in second-line patient share for Takeda's PPAR-gamma agonist Actos.

The classic pattern of type 2 diabetes treatment is metformin, a sulfonylurea and then a PPAR-gamma agonist. states Madhuri Borde, Ph.D., analyst at Decision Resources. However, due to hypoglycemia concerns with sulfonylureas and cardiovascular concerns with Avandia, this pattern is changing as drugs from the DPP-IV inhibitor, GLP-1 analogue and insulin analogue classes are gaining patient share in second- and third-line treatment.

Source: Diabetes In Contro;: Decision Resources Research Report PharMetrics