Rising status of antidiabetic SGLT-2 inhibitors

With market expansion and its rising position as a heart failure treatment

1H prescriptions record ₩82 billion… led by Forxiga and Jardiance

SGLT-2 inhibitors rise as a key drug in the new clinical practice guidelines published by the Korean Society of Heart Failure (KSHF)

Recommended in all areas including HFrEF, HFmrEF, and HFpEF

SGLT-2 inhibitors made an external growth of 16% in the first half of this year.

 

SGLT-2 inhibitors, which were first approved as a type 2 diabetes treatment, expanded into the field of heart failure and made over ₩80 billion in prescriptions in the first half of the year.

 

Being recently recommended as a major treatment option in treating chronic heart failure in domestic treatment guidelines, the growth in sales of SGLT-2 inhibitors is expected to continue to gain momentum.

 

◆ Makes ₩82 billion in total prescriptions …AZ ₩43.8 billion ·BI ₩35.7 billion According to the market research institution UBIST on the 25th, the total outpatient prescriptions made for SGLT-2 inhibitors in the first half of this year rose 15.7% from ₩70.9 billion YoY to record ₩82 billion.

 

The SGLT-2 inhibitor market size, which had been ₩50 billion 5 years ago, has been steadily expanding with the introduction of combination drugs and indication expansions.

 

In 2019, the half-year prescription amount exceeded ₩50 billion in 2019 for the first time and was on the verge of achieving annual sales of ₩100 billion.

 

Last year, the annual prescription amount exceeded ₩150 billion.

 

This growth in the SGLT-2 inhibitor market was led by AstraZeneca and Boehringer Ingelheim, which had been actively expanding their drug’s indications.

 

Prescriptions of AstraZeneca’s monotherapy “Forxiga (dapagliflozin)” and its metformin combo “Xigduo” makes up 53% of the total SGLT-2 inhibitor prescription market.

 

Boehringer Ingelheim’s single agent drug “Jardiance (empagliflozin)” and its combo drug “Jardiance Duo” accounts for 44% of the market.

 

AstraZeneca’s Forxiga has solidified its lead in the market by being the first to obtain an indication as a treatment for chronic heart failure in 2020.

 

Its outpatient prescriptions in the first half of the year were ₩23.4 billion, a 16.7% YoY increase from the ₩20 billion made in the same period of the previous year.

 

The combo drug Xigduo’s sales also increased 18.5% from ₩17.2 billion to ₩20.4 billion from the previous year.

 

The prescriptions of the two drugs amounted to ₩43.8 billion.

 

The half-year sales of Boehringer Ingelheim’s Jardiance first exceeded ₩20 billion this year.

 

Jardiance’s outpatient prescriptions in 1H this year were ₩21.2 billion, a 7.5% increase from the ₩19.7 billion in 1H of the previous year.

 

Jardiance Duo’s sales also increased 28.1% from ₩11.3 billion to ₩14.5 billion.

 

Total prescriptions of Jardiance and Jardiance Duo amounted to ₩35.7 billion in 1H this year.

 

◆Rises as a key drug in HF… Receives 'Class 1 recommendation’ in all areas of HF The status of SGLT-2 inhibitors, which are already likened to ‘21st-century statin,’ is expected to continue to rise with its recommendation as a standard of care therapy in the latest heart failure treatment guidelines in Korea.

 

In the “Completely Revised Heart Failure Clinical Practice Guidelines 2022” that was published by the Korean Society of Heart Failure (KSHF) on the 22nd, SGLT-2 inhibitors were recommended for administration regardless of the patient’s diabetic status to reduce hospitalization from HF or cardiovascular deaths.

 

In detail, in heart failure with reduced ejection fraction (EF of 40% or lower), SGLT-2 inhibitors were recommended in line with ARNI or ACE inhibitors (angiotensin-converting enzyme inhibitor), beta-blockers, and saline corticoid receptor antagonist (aldosterone antagonist) as a first-line standard of care for reducing cardiovascular deaths and rehospitalization from HF, regardless of the patient’s diabetic status.

 

(Class I, Level of Evidence A).

 

In heart failure with mildly reduced ejection fraction (EF of 41-49%) and heart failure with preserved ejection fraction (EF of 50% or higher), SGLT-2 inhibitors were recommended at a higher level than ARNI or ARB (angiotensin receptor blockers), etc.

 

(Class I, Level of Evidence B) In addition, the guideline recommends SGLT-2 inhibitors as standard therapy for diabetic patients who already have cardiovascular disease or are at high risk of developing cardiovascular disease, even without heart failure.

 

(Class I, Level of Evidence A).