KERIANG BOY: 2015

Timothy Aungst, PharmD

Timothy Dy Aungst, PharmD, is an assistant professor of pharmacy practice at MCPHS University. He graduated from Wilkes University Nesbitt School of Pharmacy and completed a PGY-1 Pharmacy Practice Residency at St. Luke's University Hospital, and then a Clinical Geriatric Fellowship at MCPHS University. He is passionate about the rise of technology in health care and its application to pharmacy. He has published primarily on the role of mobile technology and mHealth, and made multiple national and international presentations on those topics. He blogs at TheDigitalApothecary.com, and you can find him on Twitter @TDAungst.

Published Online: Friday, December 18, 2015

Insulin and Metformin: Old Drugs, New Tricks

Some pharmaceutical companies are developing new formulations of older medications to create new possibilities.

Diabetes treatment is one area ripe for such disruption, as the incidence of diabetes will only increase in the coming years and prove to be a fruitful health care market. Taking that into consideration, diabetes treatments such as metformin and insulin are being targeted for innovation by certain players looking to capitalize on this trend.

Pharmacists recognize that metformin is often a first-line agent for diabetes management, but its commonly experienced gastrointestinal (GI) side effects may discourage patient adherence. In light of this, several compounding pharmacies across the United States have started to create transdermal metformin products for their patients.

Although transdermal metformin therapy is not necessarily a new invention, it has been generating some buzz for its potential large-scale application because it reduces GI side effects in patients by bypassing the GI tract.

Westchase Compounding Pharmacy in Tampa, Florida, has actually patented the transdermal delivery of metformin therapy (US20120283332). The selling point is that patients only use approximately 10% of the usual dosage of metformin and apply anywhere from 50 mg to 200 mg topically to the inner wrists twice daily.

Although a patent exists for transdermal metformin and other companies are exploring its use, the FDA has not approved the product, so we can’t expect it to show up on our shelves anytime soon.

An even larger market at play is insulin. Many pharmacists are familiar with patients’ fears of starting insulin therapy, which commonly stems from their fear of injecting it. With that in mind, several companies are looking to create an oral formulation of insulin to curb those fears and simplify administration.

The issue with trying to bring oral insulin to the market is the physiological barrier to delivering insulin through an oral route, which is that insulin will be broken down in the stomach. To bypass this problem, researchers have been experimenting with different capsules and alternative delivery mechanisms.

One team at the University of California Santa Barbara has created capsules housing micro-patches that can survive the acidity of the stomach and attach to the intestinal walls to release insulin.

Oramed Pharmaceuticals recently made big news in a $50 million plus royalties deal with China’s leading insulin manufacturer Hefei. Oramed recently made advances on its proprietary oral insulin product in a phase 2b trial, but it’s not the only company involved in this competitive market, as Novo Nordisk, Bristol-Myers Squibb, and India-based Biocon are also looking to capitalize on it with their own oral insulin solutions.

While we are seeing new diabetes therapies such as SGLT2 inhibitors come to market, we may see some attention turn to old drugs with new delivery pathways. Stay on the lookout for upcoming news about diabetes treatments.