It is billed as an oral drug that promises to not just help diabetes patients deal with the ailment but also perhaps offer other benefits such as weight reduction and reduced cardiac risk. Denmark-headquartered global healthcare major Novo Nordisk and a leading player in the diabetes market, plans to launch this oral GLP-1 drug in India by February 2022. So far, available as different drug molecules with proven benefits beyond diabetes control but then, these have all been only as injections. The oral medication is being seen as a breakthrough technology that could change the approach and acceptance of the drug for patients in India, which today has the dubious distinction of being the diabetes capital of the world. GLP-1 stands for Glucagon-Like Peptide receptor protein, a non-insulin treatment approach.
Speaking to Financial Express Online, Vikrant Shrotriya, corporate vice-president and managing director Novo Nordisk India, says “In India, which has a high diabetes population in the world with about 77 million diabetes patients in the country, this drug in a tablet form will be much more acceptable and could improve compliance.” The product, he has comes with a strong glycemic control and additional benefits in terms of helping in weight loss.” While most of the leading doctors talk of its merits, they do feel pricing of the drug will be crucial if greater use and compliance is to happen among patients. Even the injections that are available today are expensive and run into a few thousands or around Rs 5,000 a month at least in most cases, which for a life-long medication could prove expensive for many. Shrotriya did not indicate at what price the oral drug is likely to be made available though he did seem to suggest that the company was conscious of the importance of pricing.
And then the stance of this is likely to be watched closely. Experts in the field who have looked at different ailments and the medicines and their long-term effects, see the drug as a welcome addition to the medications available for diabetes patients but the do feel focus on pricing could prove crucial. Dr Manoj Chadha, consultant endocrinologist, P D Hinduja Hospital & Medical Research Centre in Mumbai and founder, Hope & Care, the endocrine centre that he co-founded with his wife Dr Alka Chadha in Navi Mumbai, refers to some studies from abroad that seem interesting from the point of efficacy, safety and cardio protection or the long-term effects of the drug on kidney and the heart that have been looked into. Trials are apparently on now to get Indian data on the cardio vascular safety aspects. But then, on pricing, he does caution that “we still do not know the price of the oral drug, if the cost is made affordable then obviously many people will be able to take it and there could be widespread usage of the drug.”
Pointing out that drugs that can address the issues of both obesity and diabetes, both increasing in India and today emerging as biggest risk factors for Covid also, could prove crucial, Dr V Mohan, the co-founder of Dr Mohan’s Diabetes Specialities Centre, a leading Chennai-headquartered chain of diabetes centres in the country, also points to the benefits of what he calls: “new class of compounds called GLP1 receptor analogue that works through the gut and not only stimulates the secretion of insulin from the pancreas but also suppresses glucagon hormone which raises the level of glucose (or sugar) in the blood. Plus, the other benefits including weight reduction.”
But then, while the drug launch seems a much awaited one, it does not seem as the only focus area for Novo Nordisk, which according to Vikrant Shrotriya from the company, is keen to expand its overall footprint in India. For instance, in a year from now, he sees the company “having made couple of launches in diabetes, haemophilia (launch of Factor 13), build a stronger footprint in clinical trials, gain a strong foothold in R&D in India (with more than 2500 patients and 200 centres for clinical trial in India).” Novo Nordisk, he says, has “close to 57 per cent insulin market share in India by value and insulin contributes about over 80 per cent of Novo Nordisk’s business in India.” Globally, he says, “insulin contribution to Novo Nordisk business is also significant at 44 per cent of total business.”
This perhaps is significant considering that despite being a diabetes capital of the world, India’s share from a revenue perspective is still small at “between $ 200 million and $ 300 million” for the around $ 20 billion giant. But then, a virtual meeting with journalists from around the Novo Nordisk Lars Fruergaard Jørgensen President & Chief Executive Officer responding to a question from Financial Express Online sees India as an important country in Novo Nordisk’s scheme of things not just for medicines but also for its business and operations with over 4,000 employees in India and a global business services operations in India, which despite the challenges of pandemic-led lockdowns, kept the lights on.