Lilly and Boehringer's Jardiance poised for challenge to AZ's market leader Farxiga in chronic kidney disease: Spherix

Eli Lilly and Boehringer Ingelheim made news last spring with their early halt of a trial testing SGLT2 inhibitor Jardiance for chronic kidney disease (CKD) thanks to “clear positive efficacy.” Now, HCPs are taking notice—and the drug could be poised to chip away at AstraZeneca’s market lead with Farxiga for CKD patients without diabetes, a new analysis suggests. 

Life science launch analyst Spherix reached that conclusion after analyzing the results of two surveys—one of 104 U.S. nephrologists and another of 330 nephrologists, cardiologists, endocrinologists and primary care doctors.

While Farxiga is currently the SGLT2 inhibitor of choice among nephrologists, Spherix found Jardiance’s early trial stop has made an impression: Nearly 70% of the kidney specialists surveyed in April expect to write more prescriptions for the drug in the next six months in response to the news, with 14% of those expecting a “significant” increase. 

Both Jardiance and AZ’s Farxiga were originally approved as diabetes meds but also aspire to treat heart failure and kidney disease, as all three conditions are now thought to be interconnected.

Farxiga, as the first SGLT2 med to win FDA approval for CKD in patients without diabetes, continues to reign supreme with nephrologists in CKD patients with and without diabetes. However, Spherix notes the gap between Farxiga and Jardiance is much narrower for diabetic kidney disease, suggesting that its expected FDA nod for CKD even in patients without diabetes could tip the scales.

“Jardiance’s potential gain in the non-diabetic CKD patient population [should it win FDA approval] could certainly shift nephrologists’ preferences and prescribing behaviors to challenge Farxiga’s lead and close the gap in that patient segment,” Spherix said in a statement.

Meanwhile, a separate survey conducted in March and April of this year found “a clear preference” for Jardiance among cardiologists, endocrinologists and primary care doctors, according to Spherix.  Roughly half of those specialists cited Jardiance as their SGLT2 inhibitor of choice, singling it out for having “the best market access and formulary coverage,” which Spherix said “plays favorably toward its share of the market.” But Farxiga came out ahead for having the “best clinical data” to support its use in CKD patients with and without diabetes. Janssen’s Invokana and Merck and Pfizer’s Steglatro were the other SGLT2 drugs included in the survey

SGLT2 inhibitors aren’t the only new chronic kidney disease drugs HCPs are warming up to. Bayer’s mineralocorticoid receptor antagonist Kerendia, touted by the company as a potential blockbuster, is also gaining traction, as doctors become more familiar with the recently approved drug, the analysts said.

The nephrologists’ survey found the drug’s user base has more than tripled in size compared to six months ago, with nearly one-half (48%) now saying they’re using it with their diabetic kidney disease patients. That’s up from 14% a year ago. 

Among nephrologists who haven’t yet prescribed Kerendia, more than half (54%) said they plan to do so within the next six months. In many cases, they are likely to use it in combination with an SGLT2 inhibitor, the report said.

Kerendia received marketing authorization from the EU in February and won FDA approval last July. Bayer’s pharma chief Stefan Oelrich predicted last August that it could reach over 1 billion euros in peak sales.