Old diabetes drugs as good as newer ones

New medicines that are more expensive and complex are being used to treat adult-onset type-2 diabetes even before their effectiveness over the old treatment is established, reported a US study in the Archives of Internal Medicine.

New medicines that are more expensive and complex are being used to treat adult-onset type-2 diabetes even before their effectiveness over the old treatment is established, reported a US study in the Archives of Internal Medicine.

In India too, doctors are increasingly prescribing expensive new drugs when tried and tested medicines from the same category of drugs are 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 and effect on the pancreas but costs Rs 120 for 10 tablets. The patient is the loser,” said Dr CM Gulati, drug specialist and editor, Monthly Index of Medical Specialties.

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 encouraging doctors to replace it with bioglitazone, a class of drugs 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 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,” Dr Gulati said.

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.