I was first exposed to Arena Pharmaceuticals (NASDAQ:ARNA) and its main competitor Vivus (NASDAQ:VVUS) by someone I have seen and occasionally spoken to a few times in my years of following satellite radio. It is often ironic how things come about, and perhaps mysterious in how one can draw parallels between things.
When I was first exposed to satellite radio a decade ago. I saw it as a neat product but wondered why anyone would want to pay for radio. Despite that fact, I could picture a day where having a wealth of audio content on a single platform would be commonplace. Instead of wondering whether to invest in Sirius or XM, I put an equal amount of money on each. With a merger and the creation of Sirius XM (NASDAQ:SIRI), the company is now on solid footing and generating record results.
As it turns out the existence of two rivals is a blessing and a curse. The rivalry between Sirius and XM had the companies developing technology faster and adding compelling and unique content that might have taken much longer to bring on board had only one company existed in a vacuum. It was also a curse in that the rivalry led to the near collapse and bankruptcy of satellite radio.
I can't help but think that the rivalry between ARNA and VVUS carries some of the same aspects of that which existed years ago between Sirius and XM. This is a bit different though in that these companies have other ways to make money than simply a weight loss product. This affords both some protection from the woes that befell satellite radio.
As I started my look into both Arena and Vivus I saw two companies that were both very active in trying to find a solution for a very real problem that the word has today. Obesity. Let's face it. People tend to be carrying much more weight now than they did even a decade ago. Even those among us that are only slightly overweight carry an extreme concern about how they look.
Arena's weight loss product is Belviq. Vivus touts a product called Qsymia. Both have garnered an FDA approval, and both are getting ready to market the respective products. In many ways, both can offer levels of success for the respective companies. To me the key comes down to marketing, ease of use, and efficacy.
The first to gain approval was Arena. The FDA approved Belviq on June 27, 2012. A few weeks later, on July 17th, Vivus gained approval as well. While FDA approval can make a drug and the company that makes it rocket, it can also set certain restrictions that hamper the plans and aspirations a company might have had.
Both drugs were appoved for use in adults with a body mass index (BMI) of 30 or greater (obese) or adults with a BMI of 27 or greater (overweight) who have at least one weight-related condition such as high blood pressure (hypertension), type 2 diabetes, or high cholesterol (dyslipidemia). This would seem to indicate that we will have a potential battle on our hands. However, looking more deeply into the approvals one drug comes out with an advantage. Whether that advantage will be enough to win the day is yet to be seen, but for this one company it is a great starting point.
The company that I feel has the best head start is Arena. Here is why. Treatment with Belviq for up to one year was associated with average weight loss ranging from 3 percent to 3.7 percent. The results were even better for patients with type 2 diabetes. About 47 percent of patients without type 2 diabetes lost at least 5 percent of their body weight compared with about 23 percent of patients treated with placebo.
The Vivus drug does show promise that is perhaps better, but there are some more hefty restrictions. Results from the two trials Vivus had shown that after one year of treatment with the recommended and highest daily dose (highest dose not approved) of Qsymia, patients had an average weight loss of 6.7 percent and 8.9 percent, respectively, over treatment with placebo. Approximately 62 percent and 69 percent of patients lost at least five percent of their body weight with the recommended dose and highest dose of Qsymia, respectively, compared with about 20 percent of patients treated with placebo.
On the face of things it would appear that Vivus has an advantage. Patients seemed able to lose more weight in the program. However, there may some added reason for the results of the Vivus drug over Arnena. The Arena trials indicated that exercise counseling was given while the Vivus drug trial indicated actual regular physical activity. Diet and exercise can carry a big impact on the success of any program. Even if that does not account for the entire difference there are other things that I feel give Arena a better stance:
- While Arena's Belviq should not be taken by pregnant women, it has less restrictions on the subject as Qysima. The Vivus product seems to carry more risk here and will require regular tests each month to check for pregnancy. This means that a woman must be very careful when taking Qysmia. It also appears that Qysmia causes oral birth control to be less effective, compounding the pregnancy issue. This could be a hindrance to consumer acceptance. In contrast Belviq should also not be taken while pregnant, but restrictions to regular testing are not present.
- Belviq can be prescribed by a regular doctor, whereas Qsymia will need a specialist to prescribe it. Belviq does not require additional visits to a doctor while Qsymia may involve monthly visits for pregnancy tests as well as cardiac monitoring and other labwork.
- Belviq will be available at any pharmacy. Qsymia will only be available via mail order pharmacies. This makes Belviq more easily available for patients.
- Belviq has a positive impact on type 2 diabetes. This aspect alone makes this drug carry far more potential than simply weight loss.
- Beliviq requires less additional testing and study. The FDA is requiring 6 postmarketing studies as opposed to the 10 required for Qsymia.
Of course there are other things to consider as well. Treatment with Belviq may cause serious side effects, including serotonin syndrome, particularly when taken with certain medicines that increase serotonin levels or activate serotonin receptors. These include, but are not limited to, drugs commonly used to treat depression and migraine. Belviq may also cause disturbances in attention or memory. This could have the patient having difficulty in treating depression and weight at the same time. With so many people taking anti depressants, this could be a limiting factor. Of course, a doctor monitoring the situation will be the best judge.
The side effects of each are:
Qsymia - The most common side effects are tingling of hands and feet (paresthesia), dizziness, altered taste sensation, insomnia, constipation, and dry mouth.
Belviq - The most common side effects in non-diabetic patients are headache, dizziness, fatigue, nausea, dry mouth, and constipation, and in diabetic patients are low blood sugar (hypoglycemia), headache, back pain, cough, and fatigue.
In my opinion the battle between these two companies could hinge on marketing and the fact that Belviq has the distinct added benefit for type 2 diabetes. Additional approvals in Europe and beyond will keep this battle alive for some time to come.
Unlike my early bet in satellite radio where I split my investment into both competitors, I see this situation a bit more clearly and feel that Arena has the best jump on this sector of the business.
Disclosure: I am long SIRI.
Additional disclosure: I may initiate a buy in ARNA in the next 72 hours