Predicting Winners in Oral Diabetes Competition: Galvus, Alogliptin & Januvia

Implications: Oral therapies improve complianceEU approval of Galvus does not erase US doubts

Analysis: Galvus and other DPP4 diabetes drugs provide major advantages by avoiding  problems with sulfonylurea and glinides oral agents, including hypoglycemia, weight gain, and possibly b-cell death and cardiovascular disease progression.  Oral agents are always preferable for patient compliance and convenience and early experience with incretin pathway drugs including Amylin's Byetta and Symlin, and Merck's Januvia show that these are effective therapies.  However, Galvus approval in the E.U. does not erase concerns about the drug within the U.S. since pharmacokinetic and side effect questions remain compared with competing drugs (Januvia and Alogliptin).  Januvia (Merck) has first to market strength plus in low adverse events while early data on Alogliptin (Takeda) looks impressive.