Januvia and Tradjenta Battle For DPP-4 Supremacy

By Ed Miseta, Chief Editor, Clinical Leader

Valentina Gburcik, cardiovascular & metabolic disorders analyst, GlobalData	Enrique Conterno, SVP and president, Lilly Diabetes

Januvia is facing increased competition in a market space that seems to be getting evermore crowded. The DPP-4 inhibitor from Merck, which was first to market for the treatment of type 2 diabetes, racked up sales of $4 billion in 2012. However, recently released results for the third quarter of 2013 revealed an unexpectedly poor performance for the medicine. The results are being blamed on increased competition in the market, primarily from another Big Pharma titan.

Valentina Gburcik, cardiovascular & metabolic disorders analyst for research and consulting firm GlobalData, notes the competition in this space is stronger than ever, with Big Pharma firms launching new therapies into this market with a force designed to sweep away existing medicines, as well as competitors. “As most therapies within one drug class hardly differentiate from each other, and the differences between entire classes are also relatively unimpressive, business strategy behind new products now means more than anything,” notes Gburcik.

Much of the increased competition for Januvia is coming from Eli Lilly and Company. The company’s Tradjenta product, the third-to-market DPP-4 inhibitor, continues to perform very strongly in the market, according to Gburcik.

“Eli Lilly and BI (Boehringer Ingelheim) have been adopting a different strategy from Merck by working on diversification of the diabetes portfolio, and they will soon market treatments covering every single anti-diabetes drug class,” says Gburcik. “Instead of focusing on brand, Eli Lilly focuses on the most comprehensive coverage of patients’ needs, and this is certainly strengthening its relationship with payers. Meanwhile, Januvia’s trajectory is confirming that the blockbuster mentality is dying, and that one-size-fits-all medicines are no longer a recipe for continued success in the type 2 diabetes world.”

While increased competition from Lilly is certainly a concern for Merck, so too is the higher-than-expected growth of the SGLT-2 inhibitor class. Gburcik notes this is stifling factor not just for Januvia, but for the entire DPP-4 segment as a whole. “While the efficacy of this new drug class has not proven to be better than that of DPP-4, it is also not yet labeled with any negative reputation, such as the links to pancreatic cancer, associated with the DPP-4 and GLP-1 segments,” she adds.

“This, and various other developments explain the general slow-down in the whole DPP-4 category, but it might well be questioned as to why Januvia’s performance is particularly affected. We believe the answer lies in the increasing competition amongst DPP-4 products themselves. Currently, there are five of these on the market, with more expected to come, so the clash of the titans is yet to continue,” she concludes. 

According to a spokesperson for Lilly, many people with type 2 diabetes struggle to reach their HbA1c goals and manage their condition effectively. It is important that doctors work with individual patients to develop a personalized plan of action that may include simple lifestyle changes in diet and exercise along with the appropriate medications for them. Lilly Diabetes, therefore, strives to provide a portfolio of diabetes medications for every step of the diabetes journey.

“We believe the good market performance of Tradjenta is due to the combined strengths of Boehringer Ingelheim and Lilly, and the strong value proposition Tradjenta provides for a broad range of adult patients with type 2 diabetes,” notes the spokesperson. “Not only is the Alliance working well on all levels, including alignment on common goals within sales, but also Tradjenta is gaining acceptance as a potential treatment option because of its proven efficacy and demonstrated safety profile in a broad range of adult patients with type 2 diabetes.  Tradjenta is a DPP-4 inhibitor that does not require dose adjustment, regardless of renal function or hepatic impairment.”

At Lilly’s Investment Community Meeting in early October, Enrique Conterno, SVP and president of Lilly Diabetes, noted Tradjenta is now reaching 40% of new patients in U.S., and has gained momentum in Japan in the last 12 months as well.

“In 2011 we made an important and strategic decision to enter into collaboration with Boehringer Ingelheim, to partner our capabilities and gain access to our service,” says Conterno. “Advancing our own molecules further expands the reach of our portfolio. We now have the potential to expand our diabetes portfolio with as many as four new medicines in the next three years. The more comprehensive portfolio will help patients and contribute significantly to Lilly’s return to growth post 2014.”