Merck, Januvia and Blood Pressure Medicine

Monday, October 23, 2006

Narrow minded Forbes Article: Fat City

Fat City -

The article is helpful as an overview of the state of the diabetes drug market. The name and premise of the article are a little too gimicky and rife with stereotypes.

Some 400 diabetes drugs are now being tried out on animals or people. They aim to lessen the side effects of older drugs--heart failure and weight gain for starters--or stave off or reduce the need for insulin shots, the standard way of replenishing the sugar-regulating hormone. Pfizer just started marketing the first inhaled insulin product, Exubera; competitors with sleeker inhaled products are a few years behind. Meanwhile, Sanofi-Aventis is testing its highly anticipated experimental obesity pill, rimonabant, in diabetics, although U.S. Food & Drug Administration approval was delayed.


Januvia is the first in a new class of diabetes medicine known as DPP-4
inhibitor. The drug works by enhancing the body's own ability to lower blood
sugar, or glucose, when it is elevated. ...According to Dr. John Amatruda, vice
president of clinical research for Merck, the drug's label will also reflect
that its side-effect profile is similar to placebo, or fake pill. Those side
effects include runny nose, sore throat, upper respiratory tract infection and
diarrhea. Unlike current diabetes drugs on the market, DPP-4 inhibitors don't
cause weight gain, which is seen as a major benefit, as the majority of diabetes
type 2 patients are already overweight or obese. "We now have an option for
physicians of a new and novel drug which has powerful glucose lowering efficacy
without causing many of the side effects of current agents," Amatruda said. "And
it can be used both alone and in combination."

Wednesday, October 18, 2006

Does Cinnamon help fight type 2 Diabetes

To answer the question off the bat, no one knows. While this isn't related to Januvia, for those with type 2 diabetes, I've heard anecdotally that Cinnamon of all things can really help. One study shows that Cinnamon can lower blood sugar levels quite a bit and help with cholesterol []. It appears as if certain types of cinnamon contain molecules which are chemically similar to insulin -- and as such can activate insulin receptors.

The trick for some finding the right *kind* of cinnamon, which can be difficult. There are hundreds of types of cinnamon and the kind you want is commonly called "cassia" or "cinnamonium aromium" or sometimes "cinnamonium romulus" (generally the Chinese name). It is grown in Indonesia and china. Problem being that most cinnamons sold in the US are blends of Saigon Cinnamon which does not seem to have the same properties. A number of nutrition stores sell cinnamon pills (vitamin shoppe, gnc) that have the correct cinnamon in them. Currently the best price around is at GNC -- if you buy their GNC card ($15/year) it knocks a bottle of 200 pills down to about $12.

I am not suggesting you replace your medications for cinnamon, but if you are having trouble controlling your blood sugar, try adding cinnamon to your diet. If you are not having trouble, try replacing some of your medication with cinnamon.

Pubmed link to the Trial Overview

Also, here's a link to Merck's trial overview, courtesy of PubMed: Entrez PubMed

What's Januvia all about? (In plain english)

Simply put, Januvia works by decreasing the amount of sugar produced by the liver. In most type II diabetics the liver produces too much, for reasons only partly understood. Januvia also makes the pancreas produce more insulin in response to high blood sugar. This mechanism is also defective in type II diabetes, again for reasons poorly understood. Januvia does these things by a new mechanism of action, and is the first drug that affects the first problem listed above.

So we have these alpha & beta cells who aren't doing what they're supposed to do - they're producing too much glucose (or not preventing the liver from doing so), so the body's natural insulin isn't enough. So, when that happens, it would be good if the "incretin" system kicked in to regulate these naughty cells - but DPP-4 normally stops the system doing that (to a degree). Januvia stops the DPP-4 that stops the incretin stopping the dysfunctional cells, meaning Januvia indirectly stops your these cells from producing too much glucose.

Put another way, it's an upstream inhibitor of glucagon. Glucagon signals the body that it has low blood sugar. It tells the liver to produce sugars in response, because the body thinks you're in a fasting state. In a normal person glucagon is inhibited when you eat food, because insulin is released. Insulin tells the body - 'It's Dinner Time!!' - and you're liver production of sugar stops as blood sugar is used up. Apparently this system gets screwed up in people with diabetes, as the balancing act between insulin and glucagon doesn't work properly. Therefore this medication will help the body realize, that when blood sugar is high, to stop liver production of sugars (and possibly tell the pancreas to release insulin), which should aid diabetics in controlling blood sugar levels.

Januvia gains FDA Approval: Becomes the first once daily BP Med

Welcome to my new blog on Januvia specifically and blood pressure medicines more generally. Merck received U.S. approval to begin selling Januvia this morning Januvia is a new type of diabetes drug that's more versatile than existing blood-sugar control medications. Specifically it is a pill taken once / day vs. injection twice daily. This should prove popular to most users.

Here are some things to keep in mind about Januvia:

  • As the first agent in the novel class of DPP-IV inhibitors, Merck's Januvia will lead the way in growing the type 2 diabetes market from $12 billion in 2005 to over $18 billion in 2010. Dr. Wong can provide peak-year sales for Januvia.
  • Januvia is the first oral drug targeting the incretin pathway. The very first drug targeting this pathway, Amylin/Eli Lilly's Byetta, has had tremendous success in the market despite its twice-daily injectable formulation. Januvia hope to capitalize on the success of Byetta.
  • Januvia has a decent safety and side effect profile, comparable to the current market leaders Avandia and Actos, and the insulins.
  • Januvia may have a profound impact on medical practice for type 2 diabetes by delaying the progression of the disease.