Few Endocrinologists Know Ertugliflozin Beyond Name: Poll

Marcia Frellick

December 15, 2017

As type 2 diabetes drug ertugliflozin (Merck) heads toward expected approval by the US Food and Drug Administration (FDA), fewer than half of endocrinologists surveyed by Medscape said they had heard of it and of those who had, few knew much beyond the name.

Ertugliflozin is an investigational oral sodium-glucose co-transporter 2 (SGLT-2) inhibitor aimed at improving glycemic control in adults. It is expected to be approved before the end of the year, which would make it the fourth drug in its class to market.

Medscape sampled 149 member endocrinologists who responded from November 7 to 14. Respondents were provided with clinical trial data. As Medscape Medical News has reported, ertugliflozin met the primary outcomes in two yearlong phase 3 trials, VERTIS SU and VERTIS SITA2.

Only 45% of the physicians said they had heard of the drug. Of those, 20% knew it only by name and only 5% were "very familiar" with it.

Most didn't rank it high in importance in treating type 2 diabetes. Only 23% said it was important or very important; 16% said it was not at all important.

Reasons for that may be found in the theme of some of the comments within the survey responses. Comments by those who said it was only slightly important included "Isn't that different than other sglt inhibitors" and "not important unless costs much less."

At the other end of the spectrum,  comments by those who deemed ertugliflozin "very important" included "Looks like a potent agent in this class of meds"; "Good efficacy and safer"; and "Effective in lowering blood glucose; convenient [oral] medication."

Would They Prescribe?

Respondents were asked if, after reading the clinical trial data provided about the drug, and assuming ertugliflozin is approved and performs as described, how long they thought it would take for them to start prescribing. Only 7% answered that they would start prescribing within the first week, another 18% said they would prescribe it in the first month, and nearly half (46%) said they would prescribe it within 2 to 6 months.  Just more than 1 in 5 (21%) said they would likely wait at least 9 months before prescribing.

Among the 113 endocrinologists who anticipated prescribing ertugliflozin, the main reason given was efficacy (58% answered that way). Other reasons included expected insurance coverage (42%), safety profile (36%), and mode of administration (24%).

However, insurance coverage was also a barrier to prescribing: 58% said that was a top concern/reservation. Possible step edit or prior authorization forms were next at 49%; and 34% said potential side effects and adverse events in the clinical trial data were a top concern.

The poll results show the drug is expected to be prescribed to about 5% of patients with type 2 diabetes. Within the sodium-glucose co-transporter 2 drug class, ertugliflozin's entry into the market would potentially have the most effect on canagliflozin (Invokana, Janssen), which is expected in that scenario to be prescribed for 9% of patients, down from the 11% of patients who were prescribed the drug in the last 6 months before the poll.

The survey was limited to practicing endocrinologists who are US residents and treat at least 30 patients with type 2 diabetes per month. Respondents were recruited by email and given clinical trial data on ertugliflozin. Those who completed the survey received a $50 gift card.

Another drug for treating type 2 diabetes, semaglutide (Ozempic, Novo Nordisk), was approved by the FDA earlier this month.

Semaglutide is a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist. It was approved in 0.5-mg and 1.0-mg once-weekly doses, to be administered with a prefilled pen. Its approval made it the third once-weekly injectable GLP-1 receptor agonist on the US market, joining extended-release exenatide (Bydureon, AstraZeneca) and dulaglutide (Trulicity, Eli Lilly).

Semaglutide also faced similar poor recognition among physicians ahead of its approval, a previous Medscape poll showed.

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