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Victoza may be a large step forward

February 7, 2010

Analysis of:Novo Nordisk Receives US Approval For Victoza® (liraglutide) For The Treatment Of Type 2 Diabetes | www.medicalnewstoday.com

Victoza was approved at the end of January with head to head data already published vs. Byetta (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60659-0/abstract) showing greater reduction of fasting blood sugar, HbA1c, and weight with less nausea. This stands to both expand the GLP-1 market and take market from Amylin/Lilly until Byetta LAR reaches the market.

Good medical care as good as angioplasty for stable coronary artery disease

June 8, 2009

Analysis of:A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease | content.nejm.org

BARI 2D showed equivalant 5 year survival rates when patients with chest pain and had a cath showing atherosclerosis suitable for intervention but then given medical care instead (Diabetes, cholesterol, Blood pressure). As medical care will need to be done anyway after a procedure, this saves the entire cost of the procedure (commonly $25,000 to $50,000) with no net cost of life to the patient.

Tentative Value

June 8, 2009

Analysis of:AstraZeneca and Abbott Submit New Drug Application to the FDA for the Approval of CERTRIAD for the Treatment of Mixed Dyslipidemia | www.pipelinereview.com

This is needed by both Abbott and AstaZeneca to protect market share as Lipitor goes generic. However the combination has not been proven to further reduce death, stroke or heart attack better than Crestor alone. The Accord trial lipid arm will be published in 2010 testing this and will deterimine the viability of this approach.

Byetta Saves Lives

September 2, 2008

Analysis of:FDA Alert: Hemorrhagic or Necrotizing Pancreatitis in Patients Taking Byetta | www.fda.gov

1.Hypertriglyceridemia causes pancreatitis 2.Most PCP, endocrinologists, and cardiologists are not effectively treating high triglycerides, and may make it worse by recommending a low fat = high carb diet 3.Accord data with 75% reduction in death, and patients desparate for wt loss will continue to drive sales

Courage trial should redefine care in America

August 18, 2008

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

Most hospitals are financially built on their heart programs. The "agressive" medical arm is conservative by our standards yet as good as stents at far less cost. If this was truly pursued by large companies with TPA insurance plans, their overall cost would drop with large savings in healthcare costs. They will need to eliminate disincentives (copays) to proper prescribing, replacing them with incentives to providers to effect rapid change. If this is done, it will cost cardiologist, cardiac surgeons, and their supporting hospitals their profitability while saving all the other sectors.

Byetta saves lives

August 18, 2008

Analysis of:Lilly Diabetes Drug Shows a Life-Extending Promise | www.nytimes.com

The ACCORD trial results were no suprise to our diabetes practice. We have been heavy users of Byetta since launch in 2005, and have seen the same results in our population of > 2000 diabetics with over 700 on Byetta. Since the Simpson et al study in the Canadian Journal of Medicine (CMAJ 2006;174(2):169-74) showing an increase in mortality with sulfonyurea from 1.3 to 2.1 fold, but a decrease in mortality with metformin by 20%, we have abandoned the use of sulfonyureas. Yet for many patients, there is very much a need for a third agent (a second agent is de regur) with Byetta being the first (and in our experience best) next choice when the focus is on diabetes control. If weight is the primary focus, with lower levels of impairment of glucose metabolism, Byetta has assumed a second drug status in addition to Metformin. With this approach, sudden death has become a rarity, major diabetes complications a fraction of the norm, and long term stability with wt loss the norm.

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