Novo Nordisk ($NVO) is striking back against the SGLT2 drug class. Maker of the blockbuster GLP-1 diabetes drug Victoza, Novo rolled out a new meta-analysis showing that its med beat those in the other class at reducing the blood sugar metric HbA1c.
The analysis of 17 controlled trials, presented at the World Diabetes Congress in Vancouver, also suggested that patients using Victoza (liraglutide) had a better chance of hitting their blood-sugar goals.
The study is an indirect comparison among the drug regimens, rather than an actual head-to-head trial. But lead author Maria Lorenzi said that, "in the absence of head-to-head trials, this analysis provides valuable insight into the comparative outcomes with liraglutide versus SGLT-2 inhibitors" in patients whose blood sugar isn't controlled by their previous drug regimens.
The SGLT2 drugs included in the analysis were Johnson & Johnson's ($JNJ) Invokana, the first-to-market and still the class' best-selling product, plus AstraZeneca's ($AZN) Farxiga and Eli Lilly ($LLY) and Boehringer Ingelheim's Jardiance. The latter recently got a boost from an outcomes trial showing that it reduced patients' cardiovascular risks--and many analysts believe that the heart benefits are actually classwide. J&J has its own outcomes trial going on Invokana, with data expected by 2017.
Victoza is also in the midst of an outcomes trial, called LEADER, with results due as early as the first quarter of 2016. But Victoza works differently from the SGLT2 meds--it stimulates insulin production, whereas the SGLT2 meds cause blood sugar to be excreted in urine. One theory attributes Jardiance's CV trial success to the drug's diuretic effect, and diuretic drugs themselves have proven cardiovascular benefits, as Novo R&D chief Mads Krogsgaard Thomsen said on a recent earnings call.
If Victoza can show positive CV effects, it would be for a different, and potentially better, reason, Thomsen said. "My view is that it's more interesting to have an agent that, if it can interfere in the vessel wall pathology due to … [the] maladies that are ongoing in the Type 2 diabetic body, then that would be a long-term investment for the patient because you would get the legacy or the memory effect of the drug that once was used, unlike a diuretic which works when it's given and stops working after it's given the last time," he said.
But unless and until the Leader trial delivers an outcomes boost to Victoza, Novo still has to compete with the SGLT2s, which have the added advantage of being pills rather than injections, as Victoza and the other GLP-1s are. And as Bloomberg Intelligence points out, Jardiance's results came close to Victoza's in the meta-analysis, when paired with another type of drug known as a DPP-4--and with the Lilly/Boehringer drug's CV data, that could put it ahead of Victoza in the treatment lineup.