The SGLT2 inhibitor class, specifically Janssen’s Invokana (promoted by Relypsa in nephrology), is gaining momentum with nephrologists as potential DKD indications loom for AstraZeneca’s Farxiga and Boehringer Ingelheim/Eli Lilly’s Jardiance
EXTON, Pa., / September 8, 2020 / PRNewswire – With the increasing prevalence of diabetes across the United States, concern about diabetic kidney disease (DKD) remains high among nephrologists, who consistently rank it as one of the disease areas with the greatest unmet need. To better understand nephrologists’ perceptions of the disease, Spherix recently conducted the third wave of their quarterly study, RealTime Dynamix™: Diabetic Kidney Disease (US), which reveals promising trends regarding the use of SGLT2 inhibitors among nephrologists for the treatment of DKD. This research, based on the responses of 100 US nephrologists, will be continued in Q4 with a multi-specialist report evaluating trends and expectations across nephrologists, endocrinologists, primary care providers, and cardiologists.
Despite the expanded indication of Relypsa/Janssen’s Invokana in late 2019 as the only SGLT2 inhibitor to treat kidney disease in patients with type 2 diabetes, uptake has been slow within the nephrology community. This trepidation has been driven by the belief that managing diabetes is the primary care provider’s or endocrinologist’s responsibility, as well as concern around an increased risk of lower limb amputation.
However, key events through 2020 are changing the narrative and positioning the DKD market, and specifically SGLT2 inhibitors, for change. In fact, data collected in Q3 2020 already demonstrates a sizeable increase in the percent of nephrologists initiating patients on Invokana. The data was collected just prior to the end of August, when the FDA removed Invokana’s black box label warning regarding increased risk of amputation among type 2 diabetes patients, indicating that the benefits of the drug far outweigh the associated risk. This move will likely help ease nephrologist’s concerns when prescribing Invokana in the future.
The results of AstraZeneca’s Phase III trial of Farxiga (DAPA-CKD) demonstrated a reduction in the composite measure of deteriorating renal function in both patients with and without type 2 diabetes. Although nephrologists currently show a 5 to 1 preference for Invokana over Farxiga, that ratio could certainly shift if Farxiga were to snag an expanded indication, not just in diabetic CKD patients, but in non-diabetics as well. If approved, roughly one-third of nephrologists report that Farxiga could become their preferred SGLT2 inhibitor. More so, it is likely the new data will bolster the use of SGLT2 inhibitors overall among nephrologists, as they report increased confidence in the SGLT2 class and a positive impact on their intended use of the class as a result of the findings.
Interestingly, the SGLT2 class is not the first area in which Relypsa and AstraZeneca have gone head-to-head with comparable drugs. In the hyperkalemia market, Relypsa’s Veltassa and AstraZeneca’s Lokelma continue the ongoing battle for nephrologists’ potassium binder of choice. In the past month, nephrologists predictably report that their interactions with sales representatives for all SGLT2 inhibitors fall behind those for hyperkalemia products, Veltassa and Lokelma. Relypsa’s advantage to cover both Veltassa and Invokana is strong – and one that AstraZeneca will absolutely capitalize on for their Lokelma representatives if/when Farxiga gets DKD approval.
Adding more complexity and potential to the market, Novo Nordisk’s once weekly injectable GLP-1 agonist, Ozempic (semiglutide), is currently in a Phase III clinical trial (FLOW) to evaluate if it can slow the progression of CKD in patients with type 2 diabetes. If Ozempic achieves its label expansion, it will introduce an entirely new drug class to physicians’ armamentarium to treat DKD and make big waves in the market where SGLT2 inhibitors are just beginning to gain traction.
Looking ahead, while nephrologists’ future use of SGLT2 inhibitors looks promising, questions remain to optimize product success. Some nephrologists will continue to be reserved in prescribing SGLT2 inhibitors, deferring to other physicians to drive prescribing, especially for patients with underlying type 2 diabetes. Additionally, as more products receive indications for use in CKD patients, differentiation will be crucial for success – not only among nephrologists, but also among payers to ensure product access. As it currently stands, approximately nine out of ten nephrologists report that they feel the SGLT2 inhibitor brands evaluated in Spherix’s survey are at least moderately interchangeable. Future promotion of SGLT2 inhibitor brands through messaging and targeting will need to be creative and plentiful as the market continues to evolve.
About RealTime Dynamix™
RealTime Dynamix™: Diabetic Kidney Disease (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave.
About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.
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