Antidiabetic prescription trend shifts along CVD-HF option

Diabetes Care publishes analysis of prescription preference in 5 years from 2013 to 2018

Empagliflozin and dulaglutide top SGLT2 inhibitor and GLP-1 receptor agonist markets

An analysis research on last five years found oral SGLT2 inhibitor medications and GLP-1 receptor agonist injections have been highly preferred for type 2 diabetes prescription.

 

By expanding an indication to benefit cardiovascular system, these medications have been highly favored by prescribers to treat diabetic patients who experienced myocardial infarction, stroke or heart failure.

 

In the classes of SGLT2 inhibitor tablets and GLP-1 receptor agonist injections, Jardiance (empagliflozin) and Trulicity (dulaglutide) have been prescribed the most, respectively.

 

The latest anti-diabetic treatment guidelines around the world strongly recommending those two products to diabetic patients with complications of cardiovascular disorders seem to be closely related to the recent shift in prescription trend.

 

From top, Foxiga, Jardiance, Suglat

An analysis on treatment preference (from 2013 to 2018) of endocrinologist, cardiologist and other physicians associated with type 2 diabetes was published online on Diabetes Care by American Diabetes Association.

 

The detailed data was disclosed on Feb.

 

10 (https://doi.org/10.2337/dc19-1943).

 

The research team of Professor Chintan V.

 

Dave at Brigham and Women’s Hospital, Harvard Medical School, analyzed the administrative claim data from internal medicine specialists including endocrinologist.

 

In the abstract of the study, the research team explained the shifts in prescription preference followed changes in drug labels and it has been heavily affected by common case of diabetic patients having complications of cardiovascular disease.

 

The team noted a GLP-1 agonist injection with convenience of administering once weekly was highly preferred for an injection with additional option for cardiovascular disease.

 

Change 1.

 

Oral SGLT2 option to focus on additional cardiovascular benefit The detailed data of the study showed 3.4 percent of prescription for type 2 diabetic patients with myocardial infarction, stroke, or heart failure (CVD-HF) has prescribed SGLT2 inhibitor.

 

It also should be highlighted the endocrinologists and cardiologists’ SGLT2 inhibitor preference have been increased by more than 1 percent.

 

Moreover, the prescribers’ preference on drugs within the same class has shown a significant shift.

 

Prescription rate of Invokana (canagliflozin), yet to be released in Korean market, has fallen from 100 percent in 2013 to 24.9 percent in 2018, with a steep drop of 75.1 percent.

 

Whereas prescription rate of Jardiance soared from 13.9 percent to 65.6 percent in the same period and it topped the market.

 

The researchers evaluated the preference on Jardiance has vastly grown as it won an expanded indication based on cardiovascular outcome trial (CVOT) ‘EMPA-REG OUTCOME’ disclosed in December 2016.

 

The drug has confirmed to improve risk of cardiovascular events or death.

 

Although the prescription rate of Jardiance on patients with CVD-HF was increased by 5.3 percent, the rate of Invokana or Forxiga (dapagliflozin) did not show much change.

 

The research team assessed, regarding the prescription preference, “Canagliflozin had to place a black box warning to call attention to risk in amputation related safety issues, whereas the prescription preference rate on Jardiance has shifted drastically as its label changed with confirmed decrease in risk of cardiovascular events.” Change 2.

 

GLP-1 injection options influenced by administration frequency

Trulicity

The study also found the prescription preference on GLP-1 receptor agonist for patients with CVD-HF has gone up by 3.9 percent.

 

As for single medication, extended release injection with long administration term dominated the market.

 

The first-in-class GLP-1 receptor agonist Victoza (liraglutide) showed high preference rate of 72.4 percent in 2013 as once-daily option, but it was dropped by 32.1 percent in 2018 and landed at 40.3 percent.

 

On the other hand, once-weekly injection Trulicity’s preference rate climbed up by 43.8 percent from 5.0 percent to 48.8 percent in the same period.

 

The trend was consistent in subgroup analysis in patients with CVD-HF.

 

Compared to liraglutide and exenatide’s preference rate increasing by 5.1 percent and 2.1 percent, respectively, dulaglutide’s surge was notable.

 

Released in the market from 2014, Trulicity is the only drug that European Medicines Agency (EMA) and the U.S.

 

Food and Drug Administration (FDA) have indicated as primary and secondary major adverse cardiovascular events (MACE) prevention.

 

The expansion was based on a large-scale CVOT ‘REWIND’ study.

 

The team stated, “Once-weekly extended release injection Trulicity seems to have been preferred over once-daily liraglutide, and Trulicity’s impactful clinical evidence confirming cardiovascular disease benefit also has influenced prescriber’s preference.” Meanwhile in Korea, the growth of GLP-1 receptor agonist prescription volume has been prominent.

 

A market research firm, IMS Health found Trulicity, launched in Korea in June 2016, has made approximately 10.2 billion won in the fourth quarter of 2019, leaping 30 percent from the same quarter the year before.

 

It marked the first time the injection has taken over the market share over 30 percent.

 

The overall sale volume of Trulicity in 2019 reached about 37.5 billion won, about 10 billion won, or about 39 percent jump from the year before.

 

Based on sales volume, the injection’s share of overall antidiabetic injection market grew around 5 percent than the previous year and marked 28.6 percent.

 

Basically, the injection is topping the GLP-1 analogues market, excluding insulin, with 84.6 percent of the market share.