Tresiba: Lot of hype, high price and not more effective

Here are the latest Phase III results. Tresiba will come with a premium price and not deliver better efficacy. Forget the hypoglycemia...I haven't heard a doc complain about hypo with glargine since it was launched 11 years ago.

No wonder physicians and institutions continue banning pharma - more "me too" drugs that offer no more value than existing products yet come with a higher price.

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Jun 12: Results reported at the American Diabetes Association (ADA) Scientific Sessions of an open-label PIII non-inferiority, treat-to-target RCT comparing insulin degludec vs glargine in 1,030 insulin-naive adult with T2DM inadequately controlled with oral anti-diabetic medications. Similar HbA1C reductions were seen at 1 year (-1.06% versus -1.19%). The rate of nocturnal hypoglycemic was 0.25 vs 0.39 episodes per patient per year (p=0.04). Confirmed hypoglycemic rates were 1.52 vs 1.85 episodes per patient per year (p=0.11) [20].

 

If you're going to keep your job, you probably need to learn to sell insulin. Lantus doesn't show better efficacy than NPH. In a TTT trial, all insulins will show the same efficacy--the only difference will be side effects. More insulin=lower A1c. See how that works? Probably not......

 

Ah, but Lantus achieved the same efficacy once daily. It was well accepted practice that NPH usually had to be increased to two shots a day. So, you think the lower rate of hypoglycemia will be a great selling point with Tresiba, right?

In clinical practice, which is what counts, hypoglycemia has never been an issue. Not one Endo or primary care provider has ever experienced issues with hypoglycemia for Lantus.

As far as dosing interval, it is unknown whether or not Tresiba will get every other day dosing indication. Of course we know Novo will promote off label for dosing if the indication is QD.

People can't think about what they're going to do tomorrow let alone two days from now. Every other day dosing will most likely result in more issues with persistence and adherence. Hard enough to get someone to remember to do something every day. You get someone going every other day with insulin and after a while it gets even harder to keep up with. Can you imagine in the real world: "Hmmm, did I take my Tresiba yesterday or was it the day before? Hmmm, I think it was yesterday I'll wait til tomorrow." Meanwhile tomorrow is really 3 days from the last dose, etc.

What happens in the real world isn't the same as a controlled clinical trial where people are under the microscope.

New insulin at a higher price doesn't = value. Got that?

 

To the coward that started this thread. You want a real debate? Bring this to the Novo site.

 

You sound like a Novo rep. You can't stick to the discussion and quickly jump to name calling. A real debate involves people confident enough in their argument to leave out the name calling.

Go throw your silly taunts at someone else. Typical behavior you would expect from a Novo rep.

 

Really? That's your argument? No one has EVER had hypoglycemia on Lantus. Well, I guess we're living in fantasy world, so you win. I'm sure Lantus must also give everyone the ability to fly as well, huh?

Also, Lantus QD and NPH QD showed equal efficacy. Go look at your TTT trial. Again reinforcing my point--side effects are all that differ in TTT trials. Seriously, we have almost a 20% share nationwide now with Levemir, a clearly inferior product. You really think we won't wipe the floor with you with Tresiba? You've got some growing up to do.

 

Never said no one has ever had hypoglycemia. No physicians I've spoken with have ever experienced issues, as in significant number of events to cause concern. Of course people have had hypoglycemia as with all insulins.

You really think that's a market issue with Lantus? If that were the case Lantus wouldn't have $5 billion in sales.

Novo said Levemir would overtake Lantus in 5 years. So, what happened to wiping the floor? You're saying the same thing your company said 5 years ago.

 

Ok. Sounds fine. Here's to hoping the rest of your company is as arrogant as you

 

Actually, it was your CEO that was arrogant to publicly state that Levemir would take over the long acting insulin market in 5 years.

Don't try to deflect from that fact.

Sure, degludec will do quite well for a while. You're missing the outlook on what will happen to the market when glargine goes generic. NNI will price degludec at a premium. When generic glargine hits the market in two years the access for branded long-acting insulin will be significantly diminished.

 

If anyone wants to get in a price war with Novo, they can take their best shot. We can make insulin cheaper than anyone else in the world. As far as generic glaring goes, we'll see. Luckily for us, we have multiple other products and a good pipeline.

 

You are a little slow aren't you? your big scale up is contingent on a big product...I don't care how big your pipeline is if degludec is a dog you are in trouble and generic glargine on the horizon is a BIG issue-that much is obvious. As far as price war....there are no price wars in pharma that is not how it works. And we already know that Novo makes cheap insulin...lol not talking about price!

 

Keep the facts straight: You said Novo would wipe the floor...you are the arrogant one.

 

OK. But, since you've already established that no one has ever had hypoglycemia with Lantus, then it may be tough. I know we'll have studies to show, but, really, you'll have your personal word, which we know is way more important than any silly clinical trial. You're right....my arrogance (not your bullshit) is really a big problem.

 

Don't be a blowhard. I never said no one had hypoglycemia. You know what I meant, but you like being a smart ass - consistent with what you would expect from a Novo rep, because you think you're better than other people.

There's never been an issue where physicians have experienced significant issues with hypoglycemia. You don't get that because you're all about the next smart ass comment.

Novo's success is based on a very simple yet effective sales model: Pay physicians with lots of speaker programs and any other method of paying for influence. For example, One of the highest writing Endos for Victoza and Levemir made almost $250,000 in speaker fees last year. He writes almost none of our products because we don't use speaker programs other than occasionally.

It's that simple. Sunshine Law reporting kicks in next year...it will start to make an impact on the way Novo operates. There are several watch dog groups that plan on publishing reports on docs like the one I mentioned.

Good luck!

 

What about when Levemir goes off patent in 2014. That will take some Lantus share

 

Not so. Branded Levemir will be replaced by generic version. Remember, Lantus was covered on nearly every plan when NPH was there the entire time at a significantly lower price. Lantus will lose share as more new patient starts go to Tresiba. The challenge Tresiba will have is premium pricing.

 

I love your absolutes: "There's never been an issue...." My response at being a smartass is because you make proposterous statements, and you act like they're completely logical. It's funny. You're funny. Unfortunately (for you), you're not trying to be funny.

I love your quote on Novo's business model. Thanks for using another of your own personal opinion clinical trials (n=1) to try and make your point. Is your argument really that Novo outspends Sanofi? Really? You may want to do a bit of research one Sunshine laws go into place regarding who spends more on promotional speaker. I think you might be surprised. Add in, Novo Nordisk is now at 40 consecutive quarters of double-digit sales growth--it can't be because we make good products, manage our bottom line well, do an an excellent job selling, and provide great support to physicians and patients. That's just CRAZY! Surely, it must be becuase we just pay people to write. Great argument. Thanks for your wonderful insight into how to run a successful pharma company. Wonder why the rest of the company's in the industry can't seem to figure out your proposed business model.

What can I expect out of a Sanofir rep, though? It seems you're sticking with the "everyone else is pure evil, and Sanofi is great" and the "I make broad, sweeping claims with no proof" arguments. Keep running with those!!

 

Well good for you and Novo for all the growth. No doubt with such purity and perfection in all you do, you're guaranteed another 40, 80, 120 or more consecutive quarters of growth! More power to you, you are the man!

Yeah, it was just an "n of 1". Hmmm...I guess the other Endo practice just down the road that refuses to talk to Sanofi reps unless we pay them to speak...that's just another "n of 1". I guess the other Endo just an hour away that always reminds us that she's obligated to write Levemir because of how much she's paid to speak...I guess she's another "n of 1".

Nothing evil at all about bribing people...it's a common business practice in Mexico, Japan, S. Korea, Russia and a lot of other countries. Good enough for Mexico, good enough for Novo!

Keep on believing that Novo is an ethical company! When doing business a certain way is the way you've done it for a long time, it becomes ethical within the culture. It becomes the way of doing business.

You are a goody goody!!! You are simply the best at what you do!

 

What's really disappointing about this thread is the inability to see beyond the first derivative. Try this conversation with your happy docs:

'Have any problems with hypoglycemia?'

'No, it's not really a big issue for my practice.'

'What's your titration target for morning FPG?'

'120'

'Isn't Euglycemia around 50? Why don't you try to take your patients down into the 90-100 range?'

'Oh, I get nervous if a patient hits 100'

'Why is that?'

'I don't want to risk hypoglycemia, of course...'

'So, fear of hypo is actually defining your practice, then, right?'

RIGHT.

'Now, how would you feel about an insulin that can be titrated to 90 with comparable incidence of hypoglycemia to what you're getting now?'

'That would be very interesting to me.'

OK, that's not on label, but the point is: Don't ask a rank-and-file doc with 15' per patient if they're lucky about how the practice of medicine is going to change.

 

You lost the doc at "Euglycemia"...

Now, as far as the off label bit...Novo would never do that. Novo is an ethical company, one of pure moral standards and absolute integrity.