On the surface, Johnson & Johnson's decision to drop Amylin Pharmaceuticals Inc.'s pramlintide in favor of Ergo Science Corp.'s Ergoset to treat diabetes might seem a relatively straightforward decision.

Although J&J is willing to say almost nothing about its diabetes program or strategy, Ergoset appears to fulfill the pharma company's desire for a broad-brush product.

The bromocriptine mesylate dopamine D2 agonist provides a registration-ready entry into the diabetes market and is in advanced trials for obesity-related indications, with presumably a lower-cost development path than that facing AMLN's pramlintide synthetic amylin hormone (see BioCentury Extra, March 3).

By contrast, pramlintide development has begun to look like an extended learning experience that so far has resulted in several revisions of the hormone's product potential.

However, diabetes remains a complex treatment challenge, and in fact each product appears destined initially to play niche roles in the clinic. Eventually, the verdict on J&J's decision will be based on the perceived need of clinicians for additional tools to manage the disease as well as on the clinical utility that each drug is able to establish (see Diabetes Primer, A2).

On one hand, Ergoset would fit into existing regimens for Type II diabetics who haven't progressed to insulin, while pramlintide will be focused on hormone regulation in the Type I population and to a lesser extent Type II patients, who undergo insulin therapy.

Market potential: Ergoset

The largest market opportunity in diabetes is for oral treatments of early stage patients - less than half of Type II diabetics are treated with insulin - and this is where Ergoset is targeted.