Wider choice of diabetes drugs

G.S. MUDUR

New Delhi, April 1: Patients in India with uncontrolled diabetes now have a wider choice of a new class of drugs that overcomes limitations of earlier generations of diabetes medications. Two multinational companies have jointly launched in India a new drug called saxagliptin which belongs to a group of molecules increasingly being prescribed by doctors to patients with uncontrolled diabetes. The companies, Bristol-Myers Squibb and Astra Zeneca, have said India is the first Asian country where saxagliptin will be available — nine months after its debut in the US. The once-daily dose will cost Rs 38 per tablet, company officials said. Independent endocrinologists point out that two other gliptins — sitagliptin and vildagliptin — that act against diabetes in the same way as saxagliptin, have been available in India for several months. “These molecules are very effective — particularly for patients whose diabetes has progressed to a point where conventional drugs are not useful,” said Anoop Misra, director of diabetes and metabolic diseases division at Fortis Hospital in New Delhi. “But a new drug in the same class of molecules will directly benefit patients if competition leads to lower prices,” Misra said. When patients fail to control diabetes through diet and exercise, doctors typically prescribe a drug called metformin or, over time, a class of drugs called the second-generation sulfonylureas. But these conventional drugs have “limitations”, said Vinod Mattoo, medical director with Bristol-Myers Squibb. Some drugs carry the risk of hypoglycemia — a potentially dangerous state of very low blood sugar — while others increase body weight, he said. However, medical studies suggest that the gliptins overcome such limitations and are able to control all three key readings of blood sugar — fasting, post-meals and average over the past two to three months. Endocrinologists say about 60 per cent of patients with diabetes are on oral medications. Among these, about a third would be on metformin or sulfolnylurea, another third would require a combination of metformin and sulfonylurea, while the remaining would have progressed to a point where they would require either a gliptin or a gliptin in combination with one of the other two drugs. “A new gliptin would mean a wider choice and it might be able to compare different gliptins over time to look out for subtle differences,” said Ambrish Mithal, a senior consultant in diabetes at the Apollo Indraprastha Hospital, New Delhi. “The number of gliptins is likely to grow in the coming years,” Mithal said. Several gliptin molecules from other pharmaceutical companies are currently undergoing various stages of clinical trials. Studies suggest that India has more than 40 million patients with diabetes. Drug industry officials estimate that the annual market for diabetes medications in India is worth about Rs 2,000 crore.