“A look at the diabetes drug prescription trends in the U.S. and Europe reveals the increase in the proportion of SGLT-2 inhibitors. Although the corresponding share is low in Korea now, it will become similar to America and Europe over time.”

Professor Yang Yeo-ri of the Endocrinology Department at the Catholic University of Korea Seoul St. Mary Hospital said so at Thursday's conference.

Yang made a presentation titled “Market analysis of combined prescriptions of SGLT-2 inhibitors,” comparing prescription patterns of SGLT-2 inhibitors in the U.S., Europe, and Korea.

The endocrinologist analyzed the prescription trends of SGLT-2 (sodium-glucose cotransporter-2) inhibitors along with other diabetes treatments, such as metformin and DPP-4 (dipeptidyl peptidase-4) inhibitors, in the United States using data at Medicare, a public insurance system for people 65 and older and physically disabled people in America.

As a result, the prescription of sulfonylurea, an early remedy, has gradually declined. Conversely, DPP-4 inhibitors’ prescription has rapidly increased since its appearance.

SGLT-2 inhibitor prescriptions began to increase in 2014. It marked even steeper growth since 2015. After a study was released in 2017 showing the effects SGLT-2 inhibitors had on the circulatory system, the cardiovascular departments also began to prescribe them.

“The increase in SGLT-2 inhibitors’ prescription is noteworthy. However, equally interesting are changes in prescription numbers depending on drugs,” Yang said. “Initially, canagliflozin (Invokana) dominated the U.S. SGLT-2 market. However, after the release of the EMPA-REG study, a clinical trial for empagliflozin (brand name: Jardiance) on cardiac insufficiency, the drug’s prescription rapidly increased to exceed canagliflozin in 2018.”

She noted that the results of the EMPA-REG study were very positive from the medical departments’ viewpoint, adding that cardiovascular departments mostly prescribed empagliflozin. Still, the prescription share of canagliflozin was higher in departments that prescribed the drug for only diabetes treatment.

Dapagliflozin (brand name: Forxiga) also recorded a continuous increase in prescription, which Yang attributed to the treatment’s securing additional indications through various clinical trials as Jardiance did.

"Dapagliflozin's prescriptions are growing not only for cardiovascular and cardiac insufficiency areas but also in kidney-related areas thanks to an increase in related studies,” she said.

The situations are similar in Europe, Yang noted.

“In Europe, too, every time a new SGLT-2 study is released, its prescriptions increase. It is a drug marking fast prescription growth in statistically significant ways,” she added.

Professor Yang predicted that there would be changes in SGLT-2 prescriptions in Korea, too. “The recent changes in reimbursement standards for diabetes drugs will also greatly influence. That’s because insurance benefits play a big part in reality, although SGLT-2 inhibitors release various study results.”

SGLT-2 inhibitors approved in Korea include AstraZeneca’s Forxiga. Boehringer Ingelheim and Ely Lilly’s Jardiance, Astellas’ Suglat (ipragliflozin), and MSD’s Steglatro (ertugliflozin). Janssen voluntarily withdrew approval for Invokana in June 2019.

Among them, Forxiga and Jardiance are co-leaders in Korea’s SGLT-2 inhibitor market.

Professor Yang explained that the characteristic of domestic diabetes drug prescription is the active use of compounds.

“Both dapagliflozin and empagliflozin are almost not prescribed alone. Instead, they are prescribed in compounds. In addition, with the recently expanded reimbursement, two- or three-drug combo therapies receive insurance benefits, increasing their prescriptions,” she added.