Nearly half of the top-selling Type 2 diabetes drugs come from a class of drugs known as incretin mimetics. They have been linked to a painful inflammation of the pancreas called acute pancreatitis, and an increased risk of pancreatic cancer.
The list, compiled by Genetic Engineering & Biotechnology News, ranks FDA-approved type 2 diabetes drugs based on sales for the year 2013. Drugs not included in the list include those whose sales figures were withheld, such as Johnson & Johnson’s Invokana (canagliflozin), as well as the several treatments approved during 2014, such as Boehringer Ingelheim’s Jardiance (empagliflozin), Eli Lilly’s Trulicity (dulaglutuide) and AstraZeneca’s Farxiga (dapagliflozin). All four of these drugs are expected to make the top 20 list for 2014, and all four are also classified as incretin mimetics.
Incretin mimetics work by mimicking the incretin hormones that the body usually naturally produces to stimulate the release of insulin in response to a meal. They also suppress appetite and inhibit glucagon secretion. They slow gastric emptying and thus prevent a steep rise in post-prandial blood glucose levels. They are only used to treat type 2 diabetes.
Incretin mimetics that made the top-selling type 2 diabetes list and their ranking are:
- Januvia (sitagliptin) (2)
- Victoza (liraglutide) (5)
- Janumet (sitagliptin and metformin) (8)
- Onglyza (saxagliptin) + Kombiglyze (saxagliptin and metformin) (11)
- Galvus (vildagliptin) (12)
- Byetta (exenatide) (13)
- Tradjenta (linagliptin) and Jentadueto (Trajdenta and metformin) (14)
- Bydureon (exenatide) (17)
- Nesina (alogliptin) (19)
In 2013, the FDA announced it had received reports of acute pancreatitis, including fatal and serious nonfatal cases, associated with the use of incretin mimetics exenatide (Byetta and Bydureon) and sitagliptin (Januvia and Janumet). Acute pancreatitis has been associated with an increased risk of pancreatic cancer.
Several lawsuits have been filed against the makers of various incretin mimetics alleging the companies did not adequately warn the public of the risks of serious side effects involving the pancreas.
Another drug on the list of top selling type 2 diabetes treatments is Actos (pioglitazone). Actos is not an incretin mimetic but has been associated with an increased risk of bladder cancer. Actos makers Takeda Pharmaceuticals is currently involved in numerous Actos bladder cancer lawsuits.