New Combo Drugs: The One for Two Deal

You may have also read that last week the FDA approved another new “combination drug” called Avandamet (from GlaxoSmithKline) as a “first-line treatment” for Type 2 diabetes. And you may have wondered, like I always do at these Big Pharma Announcements, what the heck this means.

Combo_drugs What’s up with these combo pills for diabetes, anyway? Why stick Avandia and metformin into a single pill — other than the obvious convenience of not having to swallow so many pellets every day (not to be understated, of course)?

So I checked around and learned — from my respected friend David Kliff of Diabetic Investor — that “combo therapy is all the rage.” Besides convenience, this new form of drug offers the vendors protection from the competition of generic alternatives, seeing as none exist yet and would be sufficiently difficult to develop.

OK, score one for the Pharma companies. But what about us patients?

“Anything that helps make the patient’s life easier is good,” Kliff says. After all, how many different pills can a person be expected to remember/swallow in a day, anyway? And it’s one insurance co-pay versus two. Still, it seems that cost will be a factor, since generics are not an option.

And while we’re on the subject, what really is the difference between a “first-line” diabetes treatment versus a second or third-line option, anyway? I wondered if there was some standard timeline or diabetes threshold that must be reached in order to “up-level” a patient’s treatment.

But it seems less formal than all that. The idea is simply that when a person is diagnosed, you want start out by trying the most “natural” and least invasive treatment options. For Type 2′s, this usually means lifestyle changes, aka diet and exercise. Next, doctors move on to the most “mild” yet effective of medications, and keep adding more and “stronger” meds as necessary. This is based on the progression of the disease in each individual patient, which makes sense, and was comforting to hear in this post-“one-size-fits-all” treatment era.

Avandamet, which combines the thiazolidinedione (TZD) rosiglitazone maleate (Avandia) and metformin HCL into one pill, is apparently the first combo drug earmarked as a first-line therapy. Takeda’s similar ActosPlus Met diabetes drug was granted a second-line treatment indication.

Hmmph. So that’s the lowdown on what I call the “One for Two” diabetes drugs. {It’s a good thing I’m not a cat, or I would have died of chronic curiousity long ago.}

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6 Responses

  1. Jo
    Jo July 25, 2006 at 4:12 pm | | Reply

    The major disadvantage I see is what if you need more of one drug than the other? Then what? Another pill? I started out with Avandia .. added metiformin, switch to Actos when Avandia quit working and them maxed out on both drugs. I added Lantus and now only take Actos, at a much reduced dosage, “when needed”. My major diabetes control is through diet, metiformin and Lantus. So a pill with 2 drugs wouldn’t have done me any good at all!

  2. AmyT
    AmyT July 25, 2006 at 5:09 pm | | Reply

    Jo,
    I see your point. Come to think of it, I have a medicine cabinet full of expensive pills that my doctors “tried” with me at various points in time. So if even one portion of the combo isn’t right for you, you’re stuck with yet another useless medical product. Aargh!!

  3. Kathleen Weaver
    Kathleen Weaver July 25, 2006 at 8:24 pm | | Reply

    I take Vytorian, an heavily advertised combo drug. When it first came out, I honestly didn’t think it would be an option for me since it wasn’t on the formulary, but both Zocor and Zetia was, but my doctor convinced me to give it a try.

    Amazingly enough Medco does treat it as a formulary drug, which saves me a copay every 3 months to the tune of $62.50 a pop.

    So it DOES benefit me.

    It also comes in the common dosages so it should work well for the majority of patients.

  4. JasonJayhawk
    JasonJayhawk July 25, 2006 at 11:05 pm | | Reply

    If this new drug is the “first-line response”, then I guess exercise and diet are shuffled back as second-line responses.

    Time to call our stock brokers….

  5. paul
    paul July 27, 2006 at 6:51 am | | Reply

    Also consider Pfizer’s upcoming cholesterol medication Torcetrapib, which combines Lipitor with Torcetrapib. They did not plan to release the drug alone- so that it can’t be combined with other companys’ products. With loss of patent on Merck’s Zocor, the sales of Lipitor are falling becuase there’s a generic alternative available at 1/10th the cost. By adding Torcetrapib, Pfizer could have extend Lipitor’s shelf life by another few years.

    http://www.nytimes.com/2005/03/07/business/07pfizer.html?ex=1154145600&en=15cb7a914cf7cea9&ei=5070

    After seeing the rage of cardiologists, now they’re singing a different tune:

    http://www.nytimes.com/2006/07/26/business/26drug.html?_r=3&ref=business&oref=slogin&oref=slogin&oref=slogin

    (links courtesy of PharmaGossip: http://pharmagossip.blogspot.com/)

    Pfizer deserves credit for doing the right thing here, because it is the FDA’s job to stop these kinds of things- and they didn’t object to the initial push for the combo-only pill.

  6. Bill the diabetesdoc
    Bill the diabetesdoc August 14, 2006 at 5:58 pm | | Reply

    Amy:
    Sort of reminds me of someone’s bright idea for a combination: add multivitamins to cheap wine so the winos who drink only a liquid diet would get their vitamins…

    I discussed the pro’s and con’s, and list the available diabetes combo pills, at
    http://www.diabetesmonitor.com/combo.htm

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