10 Top-selling Diabetes Drugs - 2012

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Lantus
Sanofi
$6.674 billion

Sanofi's ($SNY) Lantus is the undisputed king of the diabetes drug category. Its sales are up 20% from the year before, and it sold 66% more than the next-best-selling diabetes drug on the list, Merck's Januvia. The long-lasting insulin product looked as if it would going to get serious competition this year from Tresiba, Novo Nordisk's entry into the category, but the FDA threw Novo an unexpected curve, asking for further study of its cardiovascular risks. That has delayed Tresiba's launch in the U.S. until 2018. Meanwhile, Sanofi is working on a new formulation of Lantus that is expected to last longer and lead to fewer episodes of low blood sugar, one of the selling points of Novo's Tresiba.

Januvia
Merck
$4.051 billion

The Type 2 diabetes drug Januvia sits near the top of the list but is teetering. There are lots of forces trying to tip it off. The FDA is taking a closer look at the increased risk of pancreatic cancer from incretin mimetics--a group that includes drugs like Byetta from Bristol-Myers Squibb ($BMY) and Novo Nordisk's Victoza, as well as Januvia. The drugs work by mimicking the incretin hormones that the body usually produces naturally to stimulate the release of insulin. The FDA concerns may have contributed to the softness seen in Januvia's first-quarter sales. They were down 4% from last year and off almost 19% from forecasts. Janumet, a combination of Januvia and metformin, grew by 4% to $409 million, but it also fell short of expectations. Going forward, Januvia faces new competition. In March the FDA approved Invokana, the first of a class of drugs called SGLT2 inhibitors to be approved in the U.S. These drugs work by causing the body to eliminate sugar in the urine instead of affecting insulin, like Januvia. Invokana, developed by Mitsubishi Tanabe Pharma, will be sold by Johnson & Johnson ($JNJ). 

NovoRapid/NovoLog
Novo Nordisk
$2.800 billion

NovoLog, or NovoRapid outside the U.S., is Novo Nordisk's fast-acting insulin used before eating to control blood sugar. Like so many insulin makers today, Novo sells prefilled cartridges that allow users to dial in a dose and discreetly take their shots, making them handy at restaurants. NovoLog can also be used in an insulin pump for up to 6 days before needing to be changed.