New class of 'intelligent' drugs a boon for older diabetics

It works only when blood sugar levels are high, and does not cause weight gain

THE first in a new class of diabetes drugs ‑ described by one doctor as "intelligent" because it adapts to sugar levels ‑ goes on sale today.

Called Januvia, it does not cause excessively low sugar levels, or hypoglycaemia, which is a serious problem faced by older diabetics.

And unlike several existing diabetes drugs, it does not cause patients to gain weight. 'This is a big plus as obesity increases the risk of diabetes.

Januvia costs $3.50 ‑ about the price of other branded diabetes drugs, but much more than generic ones ‑ for a 100mg pill, taken once a day.

It may prove a boon to older diabetics who are sensitive to medication and whose blood sugar levels can swing from one extreme to the other. When sugar levels are too low, a person can go into a coma, and even die.

Trials using animals have shown that Januvia not only preserved the beta cells in the pancreas which produces insulin, but it also was able to regenerate lost cells. Merck, Sharpe & Dohme (MSD), which developed this pill, hopes it will have the same effect on humans.

Each class of medicine works differently. There are often several brands in one class. Januvia is the first of the DPP4‑inhiibitors to hit the market.

Dr Tan Chee Eng, a diabetes specialist in private practice who has used Januvria on three patients with special permission from the authorities, calls it an “intelligent” drug.

It works only when blood sugar levels are high, by decreasing the amount of sugar released by the liver and increasing the insulin from the pancreas to deal with the sugar generated after a meal.

Once the blood sugar returns to normal, it stops its work, so there will be no over-production of insulin that could cause hypoglycaemia.

Dr Daphne Khoo, head of endocrinology at Singapore General Hospital, welcome the new drug as it gives doctors and patients more treatment options. SGH was one of three hospitals here that tested the medicine on several patients.

But Dr Khoo said that while it has fewer side effects, its efficacy is about the same as the cheaper generic medicine sulfonylurea which costs just a few cents.

Given the cost difference and the lack of long‑term data, Dr Khoo said: "It is unlikely that we would routinely use it for patients at this point."

The Health Sciences Authority has approved Januvia for use either alone, or with two other classes of diabetes medicines. It was approved for use in the United States last October.

Usually, one class of medicine is able to lower the blood sugar levels by a certain amount. For people with difficulty in controlling the levels, more than one medicine may be needed.

On Saturday, MSD held a session on the new drug for about 200 doctors.

Being the first of its class, Januvia has an advantage. But this will be challenged soon by another DPP4‑inhibitor from Novartis. Other companies are also coming out with drugs in this class.

Diabetes is a serious problem in Singapore, with more than 8 per cent of adults suffering from the disease.

High sugar levels damage the organs and blood vessels and increase a person's risk of getting heart attacks, stroke, blindness and non‑healing wounds that lead to gangrene and amputation.

Worldwide, someone dies of a diabetes‑related cause every 10 seconds. Altogether about US$4 billion (S$6 billion) worth of diabetes medicine is sold each year. This is expected to jump to US$6 billion by 2015.

Extracted from The Straits Times, May 7 2007