News came early in the year about Sanofi’s new basal insulin called Toujeo, which is a higher concentration than the long-established Lantus.
You may remember hearing rumors about this insulin years ago while it was still in development, when Sanofi execs were trying to pinpoint a final name. At the time, U-300 was the code name and many referred to it as “the son of Lantus” in diabetes water-cooler chatter.
The FDA approved Toujeo in February, and as of April, you can now get the new insulin in a familiar pre-filled, disposal pen that is labeled SoloStar just like its predecessor. Except the insulin is of course different. Toujeo has that higher concentration (U-300 instead of the standard U-100 we’ve been used to for so long), so patients can inject less volume, and it has an extended onset of action (6 hours vs. Lantus' 1.1 hours) that can help reduce risk of hypoglycemia.
One analogy Sanofi has suggested is to think of their two insulins like laundry detergent brands. Lantus is the traditional Tide in a pour-container, but Toujeo is like the contemporary pods that don’t require measuring for a single-wash. “Same cleaning power, but in a smaller delivery and higher concentration.”
Sanofi has reworked the SoloStar pen, so that it “does the math for you," meaning it automatically translates the 300 units of insulin per millimeter vs. Lantus' 100 into the same number of pen dials as you'd see with Lantus.
And their marketing boasts Toujeo's benefits: “Better than Lantus! Basal insulin lasts a full 24 hours! Fewer hypos!” Of course, they stand to win either way, since they also sell the competitor.
An invite-only media webinar in mid-August included a Q&A session with Sanofi reps and diabetes educators on Toujeo. While it was mostly what you’d expect from medical professionals engaged in marketing or even from reading the med’s manual, we did pick up some worthwhile nuggets from that webinar:
- The Toujeo pen carries 450 units instead of the typical 300
- The pen button for injection is designed to be easier to press, and you don’t have to hold it down as long (just 5 seconds, compared to 10 seconds on others)
- Sanofi isn’t sure at this time whether Toujeo will ever be sold without the pen (just by vial)
- Anyone who gets a Toujeo prescription has access to the new COACH program, which includes live one-on-one phone sessions with a CDE, alerts that can be sent to your phone to help remind you about meds, and access to online educational materials on diabetes management
But aside from all the official info on Toujeo site, we wanted -- as always -- to hear the real-world experiences of people with diabetes (PWDs) who are actually using this new drug. It may be too early to get a full picture of how the Diabetes Community feels about Toujeo, because not many are sharing their experiences yet publicly. But so far, it seems Toujeo is more capable than its predecessor of lasting a full day and just like other diabetes medications new and old, it can take some trial-and-error to get the dosing right. Whether PWDs who try Toujeo will keep using it remains to be seen.
To that end, we've kicked off the new hashtag #RealWorldToujeo on Twitter. And today we bring brief testimonies from two PWDs, one fairly newly diagosed and one veteran.
Jeff Dachis, Founder & CEO of OneDrop
Living in Northern California, Jeff was diagnosed as type 1 LADA in September 2013. He had been using Lantus as his basal insulin since diagnosis, before switching to Toujeo. He now takes 18 units once a day before bed, which is the same timing and dosage as he previously did with Lantus.
"So far, I like it as well as or better than Lantus. Yet the jury is still out," he says after a month of using Toujeo.
“Toujeo seems less like an innovation in insulin therapies and more like a marketing shift to try to extend the life of Sanofi’s patient relationships in the shadow of Lantus coming off patent protection and what could be the loss of market share in the face of generics,” he says.
- My blood sugars over the last month since I’ve used it are up about 8-10%. I average a 110 BG for the month normally and in the last month am averaging about 122, which would indicate that the advertising claims are somewhat true that you may need more Toujeo for the same level of control than Lantus -- or I’ve gotten sloppy this last month, but that is not likely.
- I have developed a weird upper chest cold in late summer which is inconsistent for me, but consistent with some potential adverse reactions found in Toujeo clinical trials for type 1s.
- I feel a little “puffier” -- also consistent with side effects for Toujeo, but also could be a lot of eating out this summer… :)
- I like the full 24-hour window and flat delivery, versus Lantus’ 22 hours, but it’s not very noticeable.
- Value: Although Toujeo is supposed to be 3x as concentrated, I can’t tell if I am injecting 1/3 of the actual amount of my previous dose and therefore using 1/3 the amount in any given pen (that seems entirely too generous of Sanofi to offer such a value -- 3 for 1!) or what is actually going on there… I’m using sample pens from my endo, so I don’t yet have a good feel for how many pens a month I’m using.
- I will likely go back onto Lantus as I've had good results (and want to kick the chest cold).
Shawn Nowatzki, high-voltage Niagara transformer power tester in New York
Diagnosed with T1D more than two decades ago at age 3, Shawn tells us he was on an insulin pump for 16 years, but in mid-August he disconnected his pump and started taking Toujeo for his daily basal. He’s also been on inhaled insulin Afrezza for four months, and says this combination is working well for him.
- It did take about a week to get used to it, whereas the doctor said it would only take a couple of days. And I am taking more insulin. On a pump, my daily basal total was 53 units. On Toujeo, I'm at 73 total units (and my doctor had started me at 40 units).
- I am taking one shot a day at 9:30am, which is different from what I did with other long-acting insulin. I tried Levemir for a time and found that if I did a shot at 9:30pm, the next day my numbers would start to rise by 7pm and I’d be in the 170 range every night before taking that next shot. That doesn’t happen with Toujeo as much. It jumps a little, but maybe only from 120 to 140 or 150. I can live with that.
- If the Toujeo is cold, it stings when going into my body. Just like with the Lantus SoloStar pen, some insulin does flow back into the pen once you’ve pushed the dosing button. That is the reason why you need to hold it down.
- My insurance company questioned my use of Toujeo at first, but didn’t have an issue after finding out I was going off my pump. That was going to be a cost savings for them, but I don't know how others will fare trying to get coverage for this new basal insulin.
Thanks, Jeff and Shawn, for sharing your thoughts on Toujeo. We would love to hear from others in the D-Community about your #RealWorldToujeo experiences, too. Feel free to leave a comment below, or drop us a line by email!