Victoza (liraglutide) is by far Novo Nordisk’s fastest growing diabetes drug with a reported 185% growth in the first nine months of 2011. Introduced in Europe during the last quarter of 2009 and during the first quarter of 2010 in the US, Victoza quickly gained considerable market share with over 400 million dollars in sales in 2010 and over 670 million dollars in sales during the first nine months of 2011.
If those figures aren’t enough to impress you, Victoza’s future looks even brighter now with its new celebrity spokeswoman – Paula Deen. Deen, 64, is the star of Food Network’s Paula’s Best Dishes. She’s famous for her Southern cooking, recipes rich in butter, sugar, and calories – all of the foods which can increase risk of type 2 diabetes.
As it turns out, Paula Deen has been privately suffering from type 2 diabetes for the last three years. Now she’s gone public with both her diabetes diagnosis and her treatment with Victoza in a Novo Nordisk initiative called Diabetes In A New Light. On the Diabetes in a New Light website, Deen advocates making simple changes to improve health, like cooking lighter dishes and becoming more active. “My hope is that you can see diabetes in a new light and that you’ll get the most out of each and every day,” she says.
Bear in mind that Paula Deen is likely receiving a large fee from Novo Nordisk to smile about her treatment with Victoza, but many non-celebrity diabetics are very happy with the drug, too. So are doctors. “Victoza has changed the way I treat patients,” said endocrinologist Mariela Glandt.
Victoza is a GLP-1 agonist, which means it mimics the action of the body’s naturally-occurring hormone, glucagon-like peptide-1, or GLP-1. GLP-1 is secreted by the intestines in response to food and increases insulin secretion from the beta cells in the pancreas. It also decreases the secretion of the blood sugar-raising hormone glucagon. Unfortunately, one can’t simply give the hormone GLP-1 to a patient because the body breaks it down quickly and makes it inactive. This is where a GLP-1 agonist like Victoza comes to play.
Like many hormone treatments, GLP-1 agonists must be given as an injection. They are very effective in bringing down blood sugar, they reduce HbA1c 1-1.5%, they lead to weight loss, they suppress appetite, and they do not often cause hypoglycemia. They even have the added benefit of decreasing lipids and blood pressure. Though they cause nausea, it is usually mild and transient.
For an endocrinologist, a drug that accomplishes all of those things without terrible side effects opens up a new door. “Until recent years, if a patient with type 2 diabetes could not achieve good metabolic control with oral medications, my only option, other than encouraging lifestyle changes, was to add insulin to the treatment, Glandt said. “And insulin does do the trick,” she continued. “It will always bring blood sugar levels down, even if it takes a while to get the dose right. But insulin causes weight gain, predisposes patients to hypoglycemia, which can be dangerous, and usually means the patient will have to check blood sugar many times a day.”
For a doctor in a clinical situation, then, who is looking for the ideal diabetes medication, something that lowers blood sugar, doesn’t cause hypoglycemia, leads to weight loss, and improves blood pressure and cholesterol, Victoza offers an appealing treatment choice. “If a patient doesn’t mind taking an injection, GLP-1 agonists seem to be our best option right now when trying to avoid insulin therapy,” said Glandt.
Despite all of Victoza’s promise, however, there are still concerns about its safety. In rats, GLP-1 therapy has shown an increased risk of medullary thyroid cancer. This seems not to be true in humans, but nonetheless, Victoza comes with a black box warning: “Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza only to patients for whom the potential benefits are considered to outweigh the potential risk.”
“I tell my patients about the potential risks,” said Glandt. They make an informed decision when they decide to start treatment with Victoza. A large majority of my patients are happy with it. Even the patients who experience side effects like nausea and vomiting will stay on the drug because they’re so pleased with its benefits and those side effects are usually temporary.”
Still, Glandt emphasizes that Victoza is relatively new. “We now have to wait and see how its effects translate into our real goal, which is to improve and save lives,” she said.
If Paula Deen’s celebrity power has enough pull, she’ll be improving lives too, not because of Victoza, but because with her campaign, she’s increasing diabetes awareness. That’s no small thing. With estimates suggesting that by 2050 one-third of Americans adults will have diabetes, the disease needs all the attention it can get.