SGLT-2 diabetes drug Jardiance outsells mkt leader Forxiga

Boehringer Ingelheim’s Jardiance, 1Q Revenue KRW 11.1 billion...AstraZeneca’s Forxiga, 8.0 billion

Forxiga’s sales remain strong despite rumors of market withdrawal of the single-agent product

Jardiance seeks reimbursement extension to cover kidney disease following diabetes and heart failure

Boehringer Ingelheim's Jardiance and AstraZeneca's Forxiga are striving for mastery of the KRW 110 billion SGLT-2 inhibitor class single-agent diabetes drug market in Korea.

 

In the first quarter of this year, Jardiance and Forxiga generated sales in the range of KRW 11.1 billion and KRW 8.0 billion, respectively.

 

Notably, this is a reversal of fortune for Forxiga, which had held the lead SGLT-2 class drug market for the past 5 years.

 

In 2020-2021-2022-2023, Forxiga was ahead of second-place Jardiance with sales of KRW 32.2 billion, KRW 38.1 billion, KRW 45.4 billion, and KRW 49.9 billion, but in the first quarter of this year, Jardiance outperformed Forxiga by nearly KRW 3 billion.

 

This is likely due to the rumor of AstraZeneca’s market withdrawal of Forxiga in Korea.

 

While news that AstraZeneca's diabetes combinations, including Xigduo (dapagliflozin-metformin) and Sidapvia (dapagliflozin-sitagliptin), will replace the single-agent Forxiga has been around for over 2 years, Forxiga had remained the market leader.

 

If the anticipated withdrawal of Forxiga takes place, sales of its competitor Jardiance will rise, as well as that of less-selling dapagliflozin products.

 

Among dapagliflozin drugs, Forxiga is followed by Boryung’s Trudapa and Hanmi Pharmaceutical's Dapalon, which generated sales of KRW 2.1 billion and KRW 1.6 billion respectively last year.

 

The reimbursement extension granted for Jardiance is also gaining attention.

 

If Forxiga is withdrawn from the market, Jardiance will be the only product that owns 3 indications - diabetes, heart failure, and kidney - among the original drugs.

 

If Jardiance were to gain reimbursement for chronic kidney disease, this would further expand its share in the SGLT-2 inhibitor market.

 

However, AstraZeneca has granted HK Inno.N Forxiga’s clinical data in chronic heart failure and chronic kidney disease.

 

In April, the indication for HK Inno.N's Dapa N Tab was extended to include chronic heart failure and chronic kidney disease.

 

However, the outlook for Jardiance’s performance is not so rosy.

 

A number of domestic pharmaceutical companies are developing a generic version of Jardiance with the goal of releasing it within the first half of next year.

 

Astellas Korea, which generated sales of about KRW 3.7 billion last year, also reported to the MFDS that it will stop supplying its drug in mid-August for business reasons.

 

In March, MSD Korea reported to the MFDS that it would supply Steglatro Tab 5 mg (ertugliflozin L-pyroglutamic acid) until May.

 

The decision was based on declining market demand.

 

SGLT-2 inhibitors inhibit glucose reabsorption in the kidneys, allowing sugar to be excreted in the urine, and have the advantages of being able to control blood sugar while not stimulating the pancreas, and reducing the risk of heart failure.

 

The downside is that as sugar is excreted in the urine, patients become more prone to hypoglycemia and urinary tract infections, both of which are less common.

 

Clinical studies have shown that dapagliflozin-based agents like Forxiga, etc.

 

were associated with a 39% reduction in the composite efficacy endpoint, which was defined as the risk of death from worsening renal function, cardiovascular and renal disease, compared with placebo.

 

Dapagliflozin also reduced cardiovascular death and heart failure exacerbation in chronic heart failure patients with reduced left ventricular systolic function with or without type 2 diabetes.

 

Chronic kidney disease is a severe and progressive disease with a high risk of heart failure and cardiovascular events, and the results above indicate the potential of dapagliflozin as a new treatment option in the area.

 

Jardiance and other empagliflozin drugs have been shown in clinical studies to reduce the incidence of cardiovascular death and hospitalization for heart failure in patients with heart failure with preserved ejection fraction who were receiving standard of care.

 

The study is regarded as the first to show empagliflozin’s effect in patients with heart failure with preserved ejection fraction.