Therapeutic Journeys in Diabetes: A focus on GLP-1 drugs
The proportion of patients starting GLP or GIP-GLP treatment without prior diabetes treatment has risen substantially in recent quarters. Our analysis accords well with historical Novo Nordisk's Wegovy in '21 and Eli Lilly's Mounjaro in '22 commentary and brings the data forward to look at 1Q 2023.
We can clearly see continued strong growth in the GLP/GIP-GLP class. We can see Mounjaro supply constraints in falling patient numbers, as well as LLY's requirement for a diabetes diagnosis to qualify for co-pay assistance, in a falling percentage of use as a first treatment for diabetes.
Investors have been interested in whether Ozempic is being used off-label broadly as a weight loss treatment, or whether high-profile examples of Ozempic mentioned in the media (e.g., during the recent Academy Awards) are in reality a limited population. As Ozempic prescription growth has accelerated rather than dropped off following the re-launch of Wegovy, this would suggest that demand in the diabetic population is real, despite some potential use off-label.
There are six key observations from the database:
- The number of treatment-naïve patients who begin diabetes treatment using a GLP has continued to rise.
- The number of patients using a GLP as their sole diabetes treatment has been rising.
- Growth of metformin the standard starting treatment, has not slowed and we continue to see growing use of all diabetes drugs in younger cohorts.
- We see a continued decline in treatment persistence for GLPs, in contrast to an alternate class (the SGLT2s).
- Persistence on obesity GLPs remains significantly lower than for diabetes GLPs.
- We see materially slower growth in database claims for GLPs over the '19-'22 period than IQVIA TRx data suggests.
Based on the database, Credit Suisse concludes that this data is consistent with increased diabetes use reflecting the 2023 ADA guidelines that focus on weight management on equal terms to blood sugar control. However, the data is also consistent with growing off-label obesity use (as evidenced by a higher percentage of first treatment, and sole agent use of GLPs, whilst the base level of metformin starts has not slowed). In addition, competition is intense. Our database shows a 5% lower growth rate of paid claims for Ozempic and 3% lower rate for Trulicity in the past 3 years than would be suggested by IQVIA TRx data. We note that Mounjaro emerged as a leading drug before supply constraints hit, and Wegovy new patient claims double that for Ozempic. Wegovy has the same active ingredient as Ozempic but is indicated for obesity.