The government has begun discussions to provide health insurance benefits for an anti-diabetic combination therapy that combines dipeptidyl peptidase 4 (DPP4) and sodium glucose cotransporter 2 (SGLT2) inhibitors, which has triggered competition from local drugmakers to join the market.

Nitto Pharmaceutical launched the DPP4 SGLT2 combination drug Qtern Tab. (saxagliptin/dapagliflozin) The collaboration with AstraZeneca has raised concerns about whether the new drug will defeat other drugs in the same combination.

On Monday, Ildong said that it launched Qtern Tab., a combination of DPP4 inhibitor and SGLT2 inhibitor, in the domestic market.

On the same day, Ildong said that it also signed an agreement with AstraZeneca to exclusively supply Qtern Tab. In the Korean market.

Product marketing and sales will take effect immediately on the day of the agreement.

AstraZeneca, the original developer of Qtern, received a license to treat type 2 diabetes in 2017.

The three combination drugs that mix DPP4 inhibitors and Korean authorized SGLT2 inhibitors are Ildong’s Qtern and Boehringer Ingelheim’s Esclito Tab. (Linagliptin/empagliflozin) and MSD's Stegluzan Tab. (Sitagliptin/ertugliflozin L-pyroglutamate).

Qtern developed by AstraZeneca uses the DPP4 inhibitor Saxagliptin (trade name: Onglyza) in combination with the SGLT2 inhibitor dapagliflozin (trade name: Forxiga).

Ildong and AstraZeneca stated that taking one pill of combination medicine a day can produce the effects of two different types of medicines.

Ildong said that if patients cannot use metformin alone or a combination of two drugs to adequately control blood sugar, they can take Qtern and metformin.

In addition, those who cannot control blood sugar with a combination of metformin, dapagliflozin or saxagliptin can use Qtern, it added.

According to Ildong, all three phase 3 clinical trials compared patients treated with each drug and metformin, and both Qtern and metformin showed improvements in blood glucose levels.

The company said that the combination of Qtern and metformin also demonstrated the effect of blood sugar control by increasing the blood glucose compliance rate (less than 7% of HbA1c) compared to other single-drug and metformin combinations.

The company added that one capsule per day can control blood sugar, which will make it easier for patients to comply with medication.

Post-market surveillance on Qtern Tab. It expires in March 2023, when Qtern's generic drugs can be listed.

Industry observers said that with the growth of the combination drug market, local drugmakers will actively launch generic drugs.