New medicines that are more expensive and complex are being used to treat adult-onset type-2 diabetes more than every before even before their effectiveness over old treatment is established, reports a US study in the Archives of Internal Medicine.
In India too, patients are being prescribed expensive new drugs when an older medicine from the same category of drugs would have been as effective, cheaper and in some cases, safer.
A case in point is glibenclamide, an anti-diabetic drug in a class of medications known as sulfonylureas that works by prodding a sluggish pancreas to make more insulin. Among the bestselling brands in India is Daonil by Aventis, which costs Rs 9 for 10 tablets, including taxes.
“Aventis, however, is now promoting a newer molecule from the same category of drugs called glimepiride (sold under brandname Amaryl) that has the same function ad effect on the pancreas but costs Rs 120 for 10 tablets. The patient is the loser,” says Dr CM Gulati, drug specialist and editor, of the Monthly Index of Medical Specialties.
India accounts for 35 million of the 246 people with diabetes in the world, estimates the World Health Organization.
Diabetes medication is the fastest growing pharmaceutical segment in India, recording sales of Rs 1,695 crore in year leading up to August 2008, as compared to Rs 1,402 crore in the corresponding period last year, shows ORG IMS data.
Another example is the anti-diabetes drug metformin, sold under the popular bandname Glucophage by Franko Indian
Pharmaceuticals for less than Rs 10 for 10 tablets. Other companies are now selling encouraging doctors to replace it with bioglitazone, a class of drug that has similar function but costs more. One of the brandnames it is sold under is Opam by Wockhardt, which costs Rs 39 for 10 tablets, almost four times more than Glucophage.
Ironically, newer is not always safer. “Bioglitazone has a similar in mode of action as metformin and works by increasing insulin ultilisation by the body, but it has some heart failure risk associated with it, which is not there in the older, cheaper drug,” says Dr Gulati.
Misadventures with new medicines with yet unknown long-term side effects are not uncommon. Two years ago, the third-line anti-diabetes drug rosiglitazone was being promoted as a wonder drug before studies showed it raised heart attack risk.
“The lesson in this is that both physicians and patients should not blindly accept new medicines and treatments as cure-alls when existing therapies have been established to be equally effective,” says Dr Anoop Misra, Head, Department of Metabolic Diseases, Fortis Group of Hospitals.
“The largescale global Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) study showed that rosiglitazone led to a 60 per cent reduction in the incidence of diabetes, which led to some doctors to even prescribe it as a drug to prevent diabetes. That is not required, especially since a healthy diet and regular exercise can help achieve a similar reduction in incidence,” says Misra.
The US study concludes by calling for need for better data to evaluate effectiveness and cost-effectiveness across old and new treatments. “Our findings suggest the importance of generating new comparative data and coupling this information with clinical and formulary guidelines that contribute to constraining costs, maximizing glycemic control and minimizing diabetes-related morbidity and mortality,” concludes Dr G Caleb Alexander of the University of Chicago Hospitals in the Archives of Internal Medicine.