 "Mounjaro, ELI Lilly")
The launch of Eli Lilly’s diabetes and obesity management drug Mounjaro could be a significant opportunity for the company even if a few thousand patients are put on this therapy, feel analysts.
Doctors warn that the drug is not for all diabetics and needs to be used with caution.
Eli Lilly launched the drug in a single dose vial following the marketing authorisation from the Central Drugs Standard Control Organisation (CDSCO). It has been priced at ₹3,500 for a 2.5 mg vial and ₹4,375 for a 5 mg vial.
Dr Hrishikesh Salgaonkar, consultant, bariatric and laparoscopic surgery, Fortis Hospital Mulund, explained the usual dosage pattern. “It is started with a dose of 2.5 mg once/week (injection-form) and gradually increases every four weeks (maximum 15 mg once/week) if tolerated well by the patient,” he said.
Speaking to Business Standard, Vishal Manchanda, analyst at Systematix said the prices of therapy can go up to ₹40,000 a month if the highest dose, that is 15 milligram (mg) a week, is administered to a patient. At this rate, the cost of therapy works out to around ₹4.8 lakh a year.
Manchanda also highlighted that Eli Lilly has supply constraints and kept the price high.
“This will help it maximise value opportunity. While it is not in the shortage list now in the US, supplies may still be tight. Even if it gets 10,000 patients, it is still a ₹500 crore opportunity,” he said.
Salgaonkar said that the drug is used for patients when diabetes is not satisfactorily controlled.
“It can also be used along with diet and exercise to help lose weight if body mass index (BMI) is 30 kg/m2 or more. Or if BMI is between 27 and 30 kg/m2 with weight related health issues like diabetes, high blood pressure or obstructive sleep apnea (OSA),” he said.
Shashank Shah, bariatric surgeon at Hinduja Healthcare, Khar, and Leelavati Hospital, said these medications are started with a low dose, with a titration to higher dose based on tolerability and effect.
“The 2.5 mg dosage is used once a week for the first month, followed by 5 mg once a week for the second month, 7.5 mg once a week for the third month, and 10 mg once a week for the fourth month,” Shehla Shaikh, consultant endocrinologist at Mumbai’s Saifee Hospital, said.
Shah added that effects of the drug are generally checked for a period of two-four weeks. If the patient does not have significant side effects and the medicine’s effect is less, only then the dose can be increased.
Shaikh added that the average weight reduction is 19.5 per cent and 20.9 per cent, with 10 mg and 15 mg dosages, respectively, per week.
“A bodyweight reduction of 5 per cent or more is considered clinically the threshold for a meaningful improvement in metabolic health,” she said.
Experts feel that the reason why the dose is escalated slowly is to reduce the risk of gastrointestinal adverse events.
“The drug not only causes weight reduction but there are also improvements with respect to cardiovascular and metabolic risk factors like waist circumference, blood pressure and insulin levels,” Shaikh said.
Doctors, however, also caution that the drug can have side effects, such as gastrointestinal discomfort, nausea, constipation, diarrhea and dehydration.
Shah stated that these drugs can also give rise to some paralysis of the stomach, which means lesser movement of the stomach and slow gastric emptying, leading to acid reflux, foul burps and abdominal discomfort.
“Gallstone disease can happen after any such medication, similarly to those with any eyesight problems. Patients should consult an ophthalmologist before starting these medications,” he added.
Sometimes patients get severe diarrhea/ vomiting leading to dehydration and acute kidney injury. It can cause hypoglycemia (low blood sugar), especially in patients with diabetes which can be fatal.
Start medication only on advice of your endocrinologist. It can cause gallstones, gallbladder inflammation (cholecystitis) and pancreatitis, which can be a serious complication.
Booster shot
> Mounjaro could be a significant opportunity even if a few thousand patients are put on this therapy
> Doctors warn that the drug is not for all diabetics, and needs to be used with caution
> The drug has been priced at ₹3,500 for a 2.5 mg vial and ₹4,375 for a 5 mg vial
> Price can go up to ₹40,000 a month if the highest dose (i.e. 15 mg a week) is administered, said an analyst at Systematix
> At this rate, the therapy can cost ₹4.8 lakh per year
