Diabetes sales rocket toward $60B, with Novo and Lilly's GLP-1s first in line for growth

Two sides of one coin will keep diabetes drug sales growing--big time--through 2025. The disease is growing fast around the world, and treatment arbiters advise a more aggressive approach to blood-sugar control.

Combine those two drivers, and diabetes will account for almost $60 billion in 2025 sales across 9 major global markets, GlobalData analysts say in a recent report. That’s almost double the $31.2 billion in brand and generic sales recorded last year.

But this rising tide of sales won’t lift all treatments equally, the analysts predict. Best positioned for growth? GLP-1 drugs, they say, which are poised to grow by 12.4% annually through the next decade. That’s good news for Novo Nordisk’s market-leading Victoza and Eli Lilly’s recent launch Trulicity, which is already grabbing share. Not to mention Novo’s once-weekly semaglutide, on track for FDA filing this year, and its once-daily oral form of that med, which GlobalData calls a “game-changer” for that class.

The GLP-1s “in my opinion, should grow,” one European opinion leader told Global Data, “because basically, whenever they have been compared to insulin as an injectable treatment [for] type 2 diabetes, the results were at least as good, if not a little bit better.”

The same doctor sees SGLT2 meds continuing to grow as well. And that growth spells trouble for the rival DPP-4 class, headed by Merck & Co.’s Januvia franchise. The GLP-1 gains--coupled with rapid shifts to SGLT2s such as Lilly’s Jardiance and Johnson & Johnson’s Invokana--mean DPP-4 drugs won’t grow nearly as quickly as they have in recent years, GlobalData’s report says.

Insulin biosims will help boost sales in that category of meds, partly because patients are more likely to stick to lower-cost regimens. Eli Lilly and Boehringer Ingelheim’s knockoff of Sanofi’s top-selling basal insulin, Lantus, is set to hit the market in December, and Sanofi has a couple of biosims in development as well, GlobalData notes, citing top diabetes doctors.

Right now, only a small number of patients are actually hitting blood glucose targets of 7% to 7.5% A1C levels, one of those doctors told the analytics firm. Doctors are pushing harder to hit those goals, so the number of people needing a second or third add-on drug will mushroom over the next 10 years. “[W]e’ll treat these people fairly aggressively” to get to those A1C levels, the doctor said, adding, “[W]e are not going to tolerate people after 8.5% and 9% like we used to.”

Plus, despite public health campaigns and awareness campaigns, people will “continue to overeat and under-exercise and they are going to see their weight continue to go up, and therefore their need for more medications will go up with it,” the U.S. doctor said.

What these doctors really want are new drugs that are more effective against the disease over the long term. Diabetes is “complicated” and “resilient,” another U.S. doctor said, so most patients have to switch drugs and add new ones as time goes on, because treatments tend to lose effectiveness after long use.

But new classes of meds are a ways off, GlobalData notes, with the late-stage pipeline filled with follow-up drugs--such as Pfizer and Merck’s SGLT2 ertugliflozin--and novel meds in Phase II or earlier. There are just two first-in-class drugs in Phase III, the analysts point out, but 150 potential meds in Phase I and Phase II.

- see GlobalData’s report

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