New data sets up Jardiance to displace DPP-4 inhibitors

New data for Jardiance, an SGLT2 diabetes therapy marketed by Lilly, could cause a fundamental shift in how doctors treat type-2 diabetes, leading them to change their prescribing habits at the second line from DPP-4 inhibitors to SGLT2 inhibitors.

Eli Lilly released top-line data from a cardiovascular outcomes trial for Jardiance that showed a reduction in the risk of heart attack or stroke compared to placebo. Lilly said it plans to release specific numbers about how great the risk reduction was in those patients at the European Association for the Study of Diabetes on September 17.

Boehringer Ingelheim and Eli Lilly developed a collaboration in 2011 to develop and co-market Jardiance.

This data makes Jardiance the only blood glucose–lowering medicine that has demonstrated it reduces the risk of heart attack and stroke in a dedicated cardiovascular outcomes trial, Evercore ISI analyst Mark Schoenebaum wrote in an investor note.

While the results have the potential to draw a higher percentage of prescriptions in the SGLT2-inhibitor class, the data could also displace another category of diabetes treatments entirely. Doctors may be less likely to prescribe DPP-4 inhibitors, such as Merck's Janumet and Januvia, as well as AstraZeneca's Onglyza, which was recently dropped from Express Scripts' formulary due to the risk of heart-failure hospitalization.

“After today, given the CV benefit, from at least one SGLT2 inhibitor Jardiance, we expect doctors will be more eager to prescribe SGLT2s in front of DPP4s,” Schoenebaum wrote.“We expect the results from the trial will make it on the Jardiance label and allow Jardiance reps to speak to the data with doctors.”

The short-term impact on DPP-4 inhibitors, however, may be minimal, Schoenebaum cautioned, due to the likelihood that “today's results will likely have a greater impact on patients insufficiently controlled and needing an additional drug” than patients who already have their blood glucose under control.