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RealTime Dynamix: Diabetic Kidney Disease US (quarterly)

An estimated 30 million Americans have Type 2 diabetes and up to 40% of these patients will develop kidney damage as a result. Indeed, diabetes is the leading cause of ESRD in the United States. Treatment has largely been limited to the use of ACE inhibitors and ARBs to control blood pres-sure and proteinuria. In September 2019, the FDA approved Janssen’s INVOKANA (canagliflozin) for DKD and there are a host of novel mecha-nism agents in development for this condition which nephrologists indicate has an exceptionally high unmet need.

RealTime Dynamix™: Diabetic Kidney Disease (US) is a quarterly service de-signed to track the shifting landscape of DKD treatment among nephrolo-gists Each quarter, Spherix surveys 100 US based nephrologists who are actively managing CKD non-dialysis patients and who meet other screen-ing criteria (70% are office-based, must spend at least 50% of time in clini-cal practice, in practice 2 to 40 years, agree to Spherix terms, regionally representative). Nephrologists complete a self-administered online survey of about 30 minutes in length with new content introduced each quarter. Nephrologists are limited to participating in this project twice per year. Once per year Spherix conducts Market Dynamix: Diabetic Kidney Dis-ease, which includes feedback from endocrinologists, cardiologists, and PCPs in addition to nephrologists; this study has been conducted since 2016.

Learn more about RealTime Dynamix™ reports here.

  • What is the relative unmet need for new DKD treatments?
  • What are the challenges of managing patients with DKD and how has patient management changed in the past year?
  • How many patients with DKD are under nephrologists’ care (by stage, by co-management)?
  • How are patients with DKD co-managed between nephrologists, endocrinologists and PCPs?
  • How comfortable are nephrologists initiating treatment with canagliflozin (and other SGLT2 agents) following the expanded indication for DKD?
  • To what degree do nephrologists consider the SGLT2 agents interchangeable? Do they have a preferred agent (why?) What drives preference and/or use of specific brands?
  •  What is the overall treatment rate for SGLT2 agents and in what percentage of cases is the nephrologist the one initiating treatment? What percentage of the non-treated patients are candidates but not yet on treatment? How satisfied are nephrologists with INVOKANA?
  •  How are nephrologists becoming familiar with canagliflozin (and SGLT2 agents)? How common is direct promotion (Relypsa representatives)? What are the main messages being communicated?
  • What are the barriers to the use of canagliflozin? Comparatively, what is the market access landscape for SGLT2 agents compared to other renal drugs
  • How familiar are nephrologists with DKD agents in development, including those for Type 1 diabetes?
  • What is their reaction to and preference for these products?

Commercial Products
INVOKANA (canagliflozin)

Pipeline Agents
Other SGLT2 inhibitors (dapagliflozin, empagliflozin, ertugliflozin)
GLP-1 receptor agonists
Bardoxolone methyl
Nidufexor (LMB763)
MEDI3516 (IL-33)
Autologus NKA


SGLT2 Inhibitors Could Induce a Seismic Shift in Treatment of Diabetic Kidney Disease in the US, According to Spherix Global Insights – September 8, 2020

Nephrologists Are Hesitant to Fully Embrace Janssen’s INVOKANA Despite Being the First and Only SGLT2 Inhibitor with an FDA Indication to Treat Diabetic Kidney Disease – June 18, 2020