Ildong makes initial lead in the SGLT2·DPP4 combo market

...further prospects remain unclear

AstraZeneca’s ‘Qtern’ prescription reach KRW 190 million in May, exceeding LG Chem’s ‘Zemidapa’ KRW 70 million

‘Sugadapa’ to enter the market in June...large amount of generics are set to enter the market after Januvia’s patent expiry in September

Pic of Qtern, Zemidapa, Esgliteo, and Sugadapa (clockwise from the upper left corner)

Full-fledged competition has begun in the ‘SGLT-2 inhibitor+DPP-4 inhibitor’ two-drug combination therapy market for the treatment of diabetes.

 

In the first month after 5 products were launched, outpatient prescriptions reached KRW 300 million, and AstraZeneca and Ildong Pharmaceutical's Qtern led the market bringing in prescriptions of KRW 200 million.

 

This market is expected to expand further after the term expires for Januvia (sitagliptin) in September.

 

Fierce competition is expected after the 86 generic companies release their two-drug combination of dapagliflozin + sitagliptin at the same time after September.

 

According to the market research institution UBIST, SGLT-2i+DPP-4i two-drug combination therapies have posted KRW 300 million in outpatient prescription sales in May this year.

 

The government had extended insurance reimbursement to cover three-drug SGLT-2i+DPP-4i+metformin combinations in April.

 

With the approval, pharmaceutical companies have been applying for the reimbursement of their SGLT-2i+DPP-4i two-drug combination therapies.

 

As of May 1st, 5 products, ▲Chong Kun Dang’s Exiglu-S Tab (dapagliflozin+sitagliptin); ▲AstraZeneca’s ‘Qtern Tab (dapagliflozin+saxagliptin); ▲Boehringer Ingelheim’s Esgliteo Tab (empagliflozin+linagliptin); ▲MSD’s Stegluzan Tab (ertugliflozin+sitagliptin); ▲LG Chem’s Zemidapa (dapagliflozin+gemigliptin), were listed for reimbursement.

 

Front-line hospitals and clinics have been prescribing these products by adding the single-agent metformin to the two-drug combinations.

 

In the first month after reimbursement listing, Qtern recorded the most prescriptions with sales of KRW 192 million among the 5 newly listed products.

 

Zemidapa followed with KRW 66 million, and then Exiglu-S with KRW 22 million.

 

Monthly prescriptions of Esgliteo and Stegluzan were less than KRW 20 million.

 

The variable in the market is the coming entry of its latecomers.

 

Over 90 companies will engage in competition by the end of the year.

 

Dong-A ST’s Sugadapa (dapagliflozin+evogliiptin) has already entered the competition this month.

 

Sugadapa was listed for reimbursement from the 1st of this month.

 

Dong-A ST started the sale of its product in May without reimbursement in advance to offset the weakness of entering the market a month later than its competitors.

 

With the addition of Dong-A ST, the number of competitors in this market has expanded to 5 domestic companies and 3 multinational pharmaceutical companies.

 

In addition to LG Chem, Chong Kun Dang, and Dong-A ST are exclusively marketing their products.

 

On the other hand, Boehringer Ingelheim has signed an agreement with Yuhan Corp to co-promote and sell its drug, and MSD with Chong Kun Dang.

 

AstraZeneca’s Qtern is exclusively sold in Korea by Ildong Pharmaceutical.

 

Also, many generics are expected to join the market from September this year.

 

Generic companies are expected to release generics of the dapagliflozin+sitagliptan combination at the same time after Januvia's patent expires in September.

 

86 pharmaceutical companies have currently received approval for their generic versions of dapagliflozin+sitagliptan.

 

The patent term for dapagliflozin (Forxiga), another drug, had expired in April.

 

Daewoong Pharmaceutical's combination drug that contains its Envlo (enavogliflozin) is also expected to be released next year.

 

Daewoong Pharmaceutical is developing a combination drug with Zemiglo (gemigliptin) to combine with its Envlo.

 

Daewoong Pharmaceutical plans to release its combination product by Q1 next year.

 

Some are predicting that the SGLT-2 inhibitor + DPP-4 inhibitor two-drug combination will not produce as good results as expected.

 

As the addition of metformin is required for the reimbursement of the two-drug combination, the criticism is that the advantage of convenience in intake offered by combination drugs has faltered somewhat.

 

In fact, prescriptions with the new products have no significant difference from the previous prescriptions that added a single DPP-4 inhibitor to SGLT-2 inhibitor+metformin two-drug combinations.

 

Therefore, industry analysis is that the SGLT-2 inhibitor+metformin combination, which was previously released in bulk with Forxiga's patent expiry, will become mainstream in the prescription market.