Hot Topics in Type 2 Diabetes: Physician Perceptions of Incretin Mimetics and TZDs ¬– Physician survey provides insights into TZD, DPP-IV, and GLP-1 usage

Introduction

Prescribing practices for the key branded non-insulin classes - TZDs, DPP-IV inhibitors, and GLP-1 agonists - vary widely among the seven major markets. Datamonitor surveyed 199 primary care physicians and specialists across these markets on their type 2 diabetes treatment choices and prescribing behavior. Key opinion leader insight is used to add color to reported prescribing trends.

Features and benefits

• Analyze country-specific physician insight on non-insulin antidiabetic use by line of therapy.
• Compare physician-reported trends and patient shares in TZD, DPP-IV inhibitor and GLP-1 agonist use by class.
• Use key opinion leader insight to explain reported trends and unmet needs in the type 2 diabetes market.
• Identify opportunities to target underserved markets and physician cohorts within type 2 diabetes treatment.

Highlights

Pioglitazone use will continue to decrease, but most expect to increase their prescribing of DPP-IV inhibitors and GLP-1 agonists. Key opinion leaders believe that DPP-IV inhibitors will be the main class to benefit following the June 2011 suspension of pioglitazone use in France and Germany because of a link with bladder cancer.

Class use varies greatly among the seven major markets. Pioglitazone is still highly used in the US and Italy, but DPP-IV inhibitors have overtaken pioglitazone by share in the other markets. GLP-1 agonists are most used in the large US market with 11% of patients.

First-in-class brands lead the field in both DPP-IV inhibitor (Januvia) and GLP-1 agonist (Byetta) classes. Januvia is likely to maintain its lead based on a longer safety record and the perceived lack of differentiation in the class, but Byetta has rapidly lost class share to later market entrant Victoza.

Your key questions answered

• Delve into primary data from 199 seven major market physicians on current usage and future trends of TZDs, DPP-IV inhibitors, and GLP-1 agonists.
• Use key opinion leader insight to elucidate differences in prescribing practices among the major markets.
• Identify the different opportunities in the type 2 diabetes treatment algorithm in each of the seven major markets.

Table Of Contents

Executive Summary
Strategic scoping and focus
Datamonitor key findings
Diabetes reports in the seven major markets
Published diabetes reports

OVERVIEW
Catalyst
Summary

INTRODUCTION
Opportunities in the diabetes treatment algorithm
The three key branded classes: TZDs, DPP-IV inhibitors, GLP-1 agonists
Methodology
Incretin mimetics and TZDs in the treatment algorithm

PRESCRIBING TRENDS AND INFLUENCES
Trends in use of key non-insulin classes
Newer classes growing as old brand falls
Pioglitazone use decreasing in all markets except Italy
DPP-IV inhibitors will continue their strong growth across the seven major markets
GLP-1 agonists show consistent uptake across all markets
Prescribing influences in type 2 diabetes treatments
Efficacy of glycemic control is most important
Grading of classes: pioglitazone scores lowered by negative perceptions
Key prescribing influencesPhysician grades can be compared by country for some of the more significant criteria used to differentiate between these drug classes. This can help to indicate why some markets show greater or lesser use of thiazolidinediones (TZDs), DPP-IV inhibitors, and GLP-1 agonists. As discussed above, overall perceptions about a drug inform physicians’ gradings for individual criteria, and so it is not necessarily enlightening to consider each criterion independently for all markets; some key reasons are discussed here.
Patient compliance with drug therapy

USE OF KEY NON-INSULIN BRANDS IN THE TYPE 2 DIABETES TREATMENT ALGORITHM
Overview of the key non-insulin branded classes
Prescribing influences and class use
Thiazolidinediones
Pioglitazone: use driven by high US patient share
Pioglitazone and bladder cancer: Patients will switch to DPP-IV inhibitors as physician choice is constrained
Rosiglitazone: many patients were switched out of the class
DPP-IV inhibitors
DPP-IV inhibitors have grown to 22% of patient share
Drug choice within the DPP-IV inhibitor class
DPP-IV inhibitor fixed-dose combinations by brand
GLP-1 agonists
GLP-1 agonists have presence across all therapy lines
Drug choice within the GLP-1 agonist class
Pipeline GLP-1 agonists can take share from marketed drugs

BIBLIOGRAPHY
Journal papers
Other sources
Datamonitor reports

APPENDIX
Datamonitor’s Type 2 Diabetes physician survey
Contributing experts
Report methodology