LONDON--Late last month, partners Eli Lilly ($LLY) and Boehringer Ingelheim announced that their SGLT2 diabetes med, Jardiance, had gone where no others had gone before. While its rivals had always either increased the risk of cardiovascular events or, at best, had no effect, the newcomer showed it could actually lower the risk of heart attack, stroke and death from cardiovascular causes.
So what does that mean for DPP-4 powerhouses like Merck's ($MRK) top-selling Januvia, which recently dispelled industry watchers' cardiac safety worries--but didn't turn up a benefit?
For now, not much, Peter Stein, Merck's VP of clinical research in diabetes and endocrinology, told FiercePharma in an interview at the European Society of Cardiology Congress. The Jardiance data won't be presented until later this month at the European Association for the Study of Diabetes annual meeting, and that's when the community will get to see exactly what the Jardiance trial shows.
If the study comes up aces, though? Even then, don't expect doctors to toss Januvia into the scrap heap, Stein said. For one, combinations "really are a part of how we treat diabetes, and not a small part--they're a major part."
"Patients with diabetes need more than one agent, and often more than two agents, to get to goal," he said.
Merck, for one, understands that. It's in late-stage development with its own SGLT2 drug, ertugliflozin, and it has a combo in the works itself. And if "prescribers strongly begin to embrace SGLT2/DPP-4 fixed-dose combinations," that could help Merck in the long run. Januvia's 73% DPP-4 market share in the U.S. should put its combo product in "reasonable shape" from 2018 on, Bernstein analyst Tim Anderson wrote in a note to investors this week.
|Merck's Peter Stein|
There are other reasons not to leave DPP-4s behind, too, according to Stein: "We individualize therapy. It's not a one-size-fits-all situation. I'm going to reach for certain drugs for certain patients. The great thing about DPP-4 inhibitors like Januvia is that it's very well-tolerated, it's very simple to take, it's a daily-medication, it's weight neutral, and so it's got a very favorable profile.
"Do I think this is going to dramatically change the use of Januvia? No," he continued. "Physicians have come to really trust it as an agent to manage their diabetes, and I think they'll continue to do so."
He's not the only doctor who thinks so. In a FirstWord Pharma survey of 172 endocrinologists, 90% of respondents said the new Jardiance data would impact their use of the product, Bernstein's Anderson wrote in a note to investors this week. 85% said it would positively influence their prescribing of SGLT2s in general.
But 73% also said it would have "no negative impact" (48%) or only a "slightly negative impact" (25%) on Januvia and its fellow DPP-4 brethren. "This supports our view that the impact to the DPP-4s will be modest, and that they are likely to hold up better than consensus is expecting," Anderson wrote.
-- Carly Helfand (email | Twitter)