The latest black box warning to land on packages of the type 2 diabetes drug Invokana (as well as its metformin combination drug Invokamet) may boost rival drug Jardiance’s sales even higher, according to Leerink Partners analyst Seamus Fernandez. He predicted the “immediate reaction” from prescribing physicians would be to switch patients taking Invokana to another drug in the same SGLT2 inhibitor class with fewer red flags, namely Eli Lilly and Boehringer Ingelheim’s Jardiance or AstraZeneca’s Farxiga.
He compared the same-drug-class switch as being similar to that made years ago when the type 2 diabetes drugs Avandia was tied to cardiovascular risks, and doctors quickly switched patients to Actos. Both drugs are in a class of type 2 diabetes drugs known as thiazolidinediones.
In 2013, Invokana, made by Johnson & Johnson’s Janssen Pharmaceuticals, became the first SGLT2 inhibitor to hit the market. It was quickly followed by other brands, including Jardiance and Farxiga. But since then, the drug class has been rife with new or strengthened warnings. Jardiance has skirted some of those issues but Invokana has been hit with the most warnings. The latest adverse event – requiring a black box warning on packages of Invokana and Invokamet only – involves an increased risk for lower limb amputations.
Since 2013, all SGLT2 inhibitors were hit with new warnings for ketoacidosis, a condition in which too much acid builds up in the blood, and serious urinary tract infections. Strengthened warnings for acute kidney injury were added to Invokana, Invokamet, Farxiga and Xigduo. And bone fracture risk warnings were added to Invokana and Invoakmet.
Meanwhile, Eli Lilly and Boehringer Ingelheim were able to produce data showing Jardiance could cut the combined rate of heart attack, stroke and cardiovascular death in high-risk type 2 diabetics. Which gives doctors more incentive to steer clear of Invokana, analysts say.
Source: Fierce Pharma