New Diabetes Drug Expected This Week

April 11, 2013 -- A new oral diabetes drug is expected to arrive on pharmacy shelves in the U.S. this week.

Many people predict that Invokana (canagliflozin), approved by the FDA in March, will be a brisk seller. That's partly because it treats type 2 diabetes in a new way.

It’s also because Invokana not only helped patients improve blood sugar control, but also lose weight and control their high blood pressure, according to maker Janssen Pharmaceutical Companies.

Losing weight can help people control their diabetes.

In one 26-week study, those on Invokana lost about 6 to 8 pounds, while those in the placebo group lost only about a pound. 

But the drug has side effects, including infections of the urinary tract, penis, and vagina. This leads some experts to have less enthusiasm for the new medicine. 

It will also cost a lot more than other diabetes drugs. The wholesale cost for Invokana is $8.77 a pill, according to Katie Mahony, a spokeswoman for Janssen. Retail cost for the 100-milligram starting dose, without co-pays or coverage, is about $10 a pill, or $300 a month.

The popular diabetes drug metformin can cost as little as 25 cents a pill.

"It's another way to control diabetes without injections," says Anthony McCall, MD. He is the James M. Moss Professor of Medicine at the University of Virginia School of Medicine in Charlottesville. He was not involved in the development of the new drug.

A new pill is welcome, McCall says, for some of the estimated 24 million Americans with type 2 diabetes, especially as an alternative to injecting insulin.

"People do have strong feelings about injectable medications," he says. However, he and other experts say they don't expect Invokana to replace other drugs, but rather to offer another option.

In type 2 diabetes, the body doesn’t make enough insulin or doesn't use it properly. As a result, blood sugar (glucose) levels rise, leading to complications such as heart disease, kidney damage, and nerve problems.

Invokana works by blocking glucose from being reabsorbed by the kidneys. That raises the amount of glucose urinated, and lowers the amount of glucose in your blood. 

The new drug is known as a selective sodium glucose co-transporter inhibitor, or SGLT2. Other drug companies are also working on this type of drug.

Other diabetes drugs work in differently. Some lower the amount of glucose made by the liver, while others stimulate the pancreas to release more insulin. And still many others work in different ways.

While Invokana isn't expected to replace other diabetes drugs, ''it's certainly promising," says Aaron Cypess, MD, PhD, of the Joslin Diabetes Center and an assistant professor of medicine at Harvard Medical School. "It's a mechanism we understand and that makes sense."

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