Truth in TV Advertising: Empagliflozin (Jardiance)

Advertisements for prescription drugs are flooding our TV screens. I don’t think that’s a good thing, but are they untruthful (forbidden) or misleading (more difficult to police)? The long recitals of terrifying side effects add a note of caution, but since they come on so late and are intoned at such high speed, it may only be a sixteenth note.  Rather than just grumble, I thought, let’s look at how their ads stack up against what we said about the drugs in The Medical Letter.

I turned on the TV and within a few minutes was rewarded with an advertisement for empagliflozin (Jardiance), featuring a middle-aged man with a neatly clipped beard and type 2 diabetes. According to the announcer, Jardiance has lowered the bearded man’s A1C and reduced his risk of a heart attack.  Accordingly, he appears to be worry-free and happy in the company of his attractive family.

Metformin is the usual drug of choice for initial treatment of type 2 diabetes. Empagliflozin (Jardiance) is an SGLT2 inhibitor, one of several drugs and drug classes competing to be the second line of treatment. Our article on Drugs for Diabetes (Nov 4, 2019) includes a table comparing the different classes. SGLT2 inhibitors do lower A1C, of course, but less so than GLP-1 receptor agonists, sulfonylureas, or thiazolidinediones. So the advertisement is technically correct in this regard, but misleading for a lay audience in its implication about the A1C-lowering powers of the drug.

What about reducing the risk of a heart attack or, more broadly, a major adverse cardiovascular event? Our February 25, 2019 article on Cardiovascular Benefits of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Type 2 Diabetes shed some light on that. At that time, only 3 drugs were approved by the FDA specifically for cardiovascular risk reduction in patients with type 2 diabetes and established cardiovascular disease: empagliflozin, canagliflozin (Invokana, another SGLT2 inhibitor), and liraglutide (Victoza, a GLP-1 receptor agonist). Semaglutide (Ozempic) and dulaglutide (Trulicity) have been approved since. Here again our article includes a table that summarizes the pertinent facts. In clinical trials, all of these drugs significantly reduced the risk of major adverse cardiovascular events in patients with type 2 diabetes and established cardiovascular disease. So once again the advertisement is technically correct; Jardiance has reduced the risk of a major adverse cardiovascular event, and I guess it would be unreasonable to expect a confession that other drugs can make the same claim.

I will keep watching. I suspect that other claims for prescription drugs on TV may be even more selective in the information they provide.

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Comments

  1. David Morris says:

    More often than not, commercials scare my patients away from a medication, and some refuse to take a medication if they have seen the ad on TV. I have not been able to get that point across to the drug companies.

  2. I’m always curious as to how effective these ads are? I assume the drug companies have data to support the cost outlay, but I agree with David Morris above – the warnings about side effects seem more scary than the appeal of the claims of efficacy.

  3. Jorge Saad, MD, MPH says:

    Comment:TV advertising is very expensive. It increases cost of already over prized medications. Also, the side effects should be mentioned AT THE SAME PACE AND VOLUME as the benefits of the medication. My experience is that the drug advertising effect on patients depend on their level of education. The less educated patient want and demand to be switched to the new medications because they belief that “if is on TV is because is truly better.” I have been told that several times.

  4. Dave Apgar, PharmD, CAPT US Public Health Service (retired) says:

    I have always disagreed with the concept of direct to consumer advertising (DTCA) in any venue and for any prescription drug. The US and New Zealand are the only developed countries that allow/tolerate them (and the European Parliament rejected the idea in 2002). This topic has been a subject of my study and scrutiny while I taught at a College of Pharmacy for 12 years. Most comments made in these ads are “technically” correct, as Dr Abramowicz found. However, for most of the population, much of what is emphasized (and perhaps more of what is de-emphasized) in the content of these ads is very (albeit intentionally) misleading. I have often wondered how successful these ads can possibly be, given that the best a patient can do is request the medication from the prescriber. However, as suggested in a comment above, if Big PhRMA member companies think they may help, it is easy to simply pass on advertising cost to the consumer. I personally believe that the FDA should scrutinize these misleading ads better, but of course, given their limited resources this will not happen in our current political environment. A good history of DTCA is available from NCBI here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690298/).

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