Diabetes Drugs Debate: Old or New Medications?

July 16, 2007 — -- When it comes to prescription medication, newer might not necessarily be better, according to a new study.

This time, it's drugs for diabetes: A new analysis found that older drugs were just as safe and effective as newer, highly touted diabetes drugs, such as Actos and Avandia.

"I think the message from this study is to consider the tried-and-true drugs and remember that they can most likely be the most effective and most affordable," said Gail Shearer, director of health-policy analysis for Consumer's Union.

Consumer's Union found that older drugs, such as metformin — sold under the name Glucophage — can cost consumers $38 to $60 a month for the generic medication. Actos, on the other hand, runs about $140 to $240 a month; Avandia, from $130 to $260 per month.

The Consumer's Union's study serves as a consumer guide to accompany an analysis published Monday by the Annals of Internal Medicine.

Avandia's sales have already taken a hit, after a recent study linked the drug to increased heart problems. This latest report is likely to depress sales further.

However, Melinda Stubbee, spokeswoman for GlaxoSmithKline, Avandia's manufacturer, said the study contained no new information and was only a review of older, short-term studies.

Stubbee instead cites a larger, long-term clinical study that, she said, "has recently shown Avandia has greater long-term effectiveness and a safety profile comparable to the most commonly prescribed diabetes medicine."

Takeda Pharmaceuticals, which makes Actos, declined to comment ahead of the Federal Drug Administration, which will take up the issue of the diabetes drugs' safety and effectiveness later this month.

But, those who follow the pharmaceutical industry say there's a broader lesson here — that many new drugs, often marketed as blockbuster medications, are anything but.

"Companies spend a huge amount of money to launch a drug and try to get people to use it, and often mislead patients and doctors into thinking the drug is safer or more effective than it is," said Sidney Wolfe, editor of consumer advocacy group Public Citizen's WorstPills.org Web site.

In the last few years, studies have shown newer drugs to treat schizophrenia, hypertension and blood clots were not more effective than older medications.

"Every one of us is waiting for the pill that makes it possible for us to live longer, and scientists and pharmaceutical firms are working feverishly to provide the newest and best and latest pill," said Dr. Nortin Hadler, professor of medicine at the University of North Carolina's school of medicine.

"We forget to ask whether or not taking this pill really advantages me," he said.

Industry spokesman Alan Goldhammer, deputy vice president for regulatory affairs at Pharmaceutical Research and Manufacturers of America, counters with the argument that the pharmaceutical industry is always looking to develop drugs for "unmet medical needs."

"While there are a lot of older drugs on the market — oral, anti-diabetic drugs on the market — there is always a need for new drugs that have a different benefit-risk profile, because patients are going to need a variety of different drugs to choose from so that their doctor can get the best therapy for them," Goldhammer said.

Goldhammer also insists that drug companies, which spent $5 billion advertising to consumers last year, are not overhyping new drugs.

"They can't do that," he said. "They are bound by what the drug was approved for and the benefits and risks that that drug poses."

But Hadler points to the marketing as part of the larger issue. "If it's new and it's licensed and it supposedly does what it's supposed to do, then I want it first," he said. "And that's the American attitude. The marketing just helps us have that attitude."

Companies are selling, and consumers are buying — though Monday's report makes it clear that's not always the best prescription.