India houses over 62 million diabetics and is next only to China, which has the highest population of diabetics in the world. At a time when the number is estimated to reach 100 million by 2030, Janssen and AstraZeneca have introduced a new class of drugs, the SGLT2 inhibitors, to treat type 2 diabetes in India.
The $26-billion AstraZeneca is a British-Swedish multinational. Janssen is the pharma subsidiary of the $74-billion health and wellbeing giant Johnson and Johnson (J&J). The SGLT2 inhibitor works by preventing the kidneys from reabsorbing glucose back into the blood. This allows the kidneys to lower blood glucose levels and the excess glucose in the blood is removed from the body via urine.
In India, Janssen’s Invokana was launched in March this year. It was soon followed by AstraZeneca’s Forxiga in June. Forxiga was the first SGLT2 inhibitor in the world to gain regulatory approval to treat type 2 diabetes in Europe in November 2012. Invokana gained its first regulatory approval, a year later, in the US, in March 2013. According to Janssen, the efficacy of Invokana was studied in trials involving over 10,000 patients, making it one of the largest development programmes for type 2 diabetes in the world.
“Our number one priority is to bring innovative treatment solutions to the large number of diabetic patients in the country,” said Sanjay Murdeshwar, Managing Director, AstraZeneca Pharma India. “There are various ranges of treatments available for different types of diabetic patients as it is a complex therapy, and obviously we are expanding our portfolio to increase the treatments appropriate for patients,” he added on the competition.
Claims discounted price
A Janssen India spokesperson said, “In order to reach the 67 million patients in India, we believe it is essential that healthcare practitioners have a range of treatment options to best meet their patients’ needs, including those provided by our competitors.”
AstraZeneca’s Forxiga has been made available at Rs 43 per dose in India, which the company said is at a 75 per cent discount to its price in developed markets. Janssen’s Invokana has been priced at Rs 51 per tablet.
Invokana brought in $278 million during the first quarter of 2015 for J&J, and analysts say it is on way to achieve blockbuster status.
When contacted, Sarabjit Kaur, analyst, Angel Broking said, “The addressable market for these drugs is around Rs 5,000 cr-Rs 6,000 cr (approximate estimate), growing at 18-20 per cent pa. Given that they are new generation drugs, they can enjoy a higher market share, given higher efficacy.” The market for type 2 diabetes treatments in the Asia-Pacific (APAC) region is estimated to rise in value to $10.5 bn by 2020 from the current $6.5 bn, according to GBI Research.
SGLT2 inhibitors, though, come with the downside that they may trigger ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones that may require hospitalisation. In May this year, the US drug regulator Food and Drug Administration (FDA) issued a warning in this regard.
“We are continuing to investigate this safety issue and will determine whether changes are needed in the prescribing information for this class of drugs...,” it said.