Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that recent reports citing safety concerns over GlaxoSmithKline's Avandia and the Food and Drug Administration's decision to add black box warnings about cardiovascular risk to the packaging of Avandia and Takeda's Actos will diminish the dominance of these agents in second-line diabetes therapy. As a result, Merck's Januvia could challenge Avandia and Actos for market share.

The new report Treatment Algorithms in Type 2 Diabetes finds that Avandia and Actos are prescribed to 32.2% of second-line patients, according to patient-level claims data. These drugs together generated nearly $6 billion in sales in 2006 and had been on pace to strengthen this position. However, the report finds that patients and physicians will be far more reluctant to choose these therapies when other viable and equally convenient options exist.

"The timing of this news could not be worse for GlaxoSmithKline and Takeda," said Donny Wong, Ph.D., analyst at Decision Resources. "Merck's Januvia is the first in a new class of oral agents for type 2 diabetes with the potential to challenge Avandia and Actos. Januvia has already enjoyed rapid uptake since its launch in 2006 and the obstacles facing Avandia and Actos will dramatically accelerate uptake of this novel therapy."

The report also finds that, owing to its inconvenience, insulin will never become a dominant option for first- or second-line treatment but is still used in later lines of therapy. Survey results revealed that 67% of primary care physicians and 37% of endocrinologists consider prescribing insulin only as a last resort. Additionally, physicians' pessimism regarding Exubera - Pfizer's recently introduced inhaled insulin - is still high, based on the drug's high cost, unwieldy delivery device, and possible long-term safety risks. Only 18% of primary care physicians and 12% of endocrinologists predict an increase in the use of Exubera.

About Treatment Algorithm Insight Series

Decision Resources combines in-depth primary research with the most extensive claims-based longitudinal patient-level data from PharMetrics® to provide exceptional insight into physicians' prescribing trends and the factors that drive therapy product choice, from diagnosis through multiple courses of treatment, for a specific disease.

For each disease examined, Decision Resources' Treatment Algorithms Insight Series provides the following:

  -- Summary of U.S. medical practice based on interviews with leading      experts in the field.   -- Qualitative diagnosis/referral/treatment algorithm for the United      States.   -- Drug usage by lines of therapy (1st, 2nd, 3rd line).   -- Discussion of key freeform combinations by lines of therapy.   -- Product share (class and specific compound level) within each line of      therapy (1st, 2nd, 3rd line).   -- Progression of therapy from key 1st line products.   -- Pathway to key therapies from previous therapies.   -- Qualitative analysis of 2-year forecast incorporating upcoming      launches, changes in reimbursement, and more.    About Decision Resources 

Decision Resources, Inc., ( is a world leader in healthcare market research publications, advisory services, and consulting designed to help clients shape strategy, allocate resources, and master their chosen markets.

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

  For more information, contact:   Elizabeth Marshall   Decision Resources, Inc.   781-296-2563 

SOURCE: Decision Resources, Inc.

CONTACT: Elizabeth Marshall of Decision Resources, Inc., +1-781-296-2563

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