The type 2 diabetes therapeutic market in China - the third largest after the US and Japan - will grow 10% annually to 2017, when it will be worth $3.5 billion, say new forecasts.

Fuelling this expansion are growing numbers of drug-treated patients and the increasing use of dipeptidyl peptidase-4 (DPP-IV) inhibitors, glucagon-like peptide (GLP-1) receptor agonists and insulin analogues, says the study, from Decision Resources.

Although further generic erosion of older oral anti diabetics is expected, recently-launched DPP-IV inhibitors - Merck's Januvia/Janumet (sitagliptin), Bristol-Myers Squibb/AstraZeneca's Onglyza (saxagliptin) and Novartis' Galvus (vildagliptin) - and GLP-1 receptor agonists - BNS/AstraZeneca's Byetta (exentadine) and Novo Nordisk's Victoza (liraglutide) - will continue to enjoy market exclusivity and garner higher patient share in China to 2017.

The study expects biosimilar versions of insulin analogues, both long- and short-acting, to have only a modest impact on China's type 2 diabetes market during the period. Most biosimilar insulins are only fractionally less expensive than the originators, which encourages physicians and patients to stay with branded insulins.

Together with the launches of additional novel agents, western branded therapies will consistently capture over 70% of sales in this market by 2017, says the study, which also reports that Chinese physicians show strong interest in DPP-IV inhibitors and GLP-1 receptors agonists.

DPP-1V inhibitors are favoured because of their improvement in glycemic control without the risk of hypoglycaemia, while GLP-1 receptor agonises are effective in lowering HbA1c and body weight and are therefore ideal for obese type 2 diabetes patients. 

However, due to their high prices and lack of reimbursement, physicians who currently prescribe these drugs do so mostly in the second- or third-line setting, after their patients fail to maintain glycemic control with less expensive options.

Meanwhile, patients need to be in good financial standing to afford the high out-of-pocket payments. Over 95% of Chinese residents have access to some form of government-sponsored medical insurance, but broad access does not translate into affordable healthcare, the report cautions. 

"Select DPP-IV inhibitors and GLP-1 receptor agonists have a reasonable chance of being included on the next version of the National Reimbursement Drug List [NRDL], likely to be released in 2014. However, in order to control treatment costs, the reimbursement of these agents will be restricted to specific type 2 diabetes patient groups," says Jing Wu, an analyst at Decision Resources.