Lantus is being replaced

Lantus is a long-acting basal insulin which has been around since 2000. That’s about to change, but don’t panic. Essentially it’s just a name change.

History

Lantus is a U100 form of insulin glargine, made by Sanofi. Its patent protection eventually ran out, so new versions started appearing from other companies.

Lilly (who also make Humalog) now sell Basaglar (a “biosimilar” U100 insulin glargine) in the US, but it is not on the Australian PBS.

Back in October I wrote about the PBS introduction of Semglee, a U100 insulin glargine from Mylan. I think there has been pushback from medicos on the ability of pharmacists to do brand substitution on an as-important medication as insulin though. I don’t know anything about the sales figures.

Incidentally Toujeo is Sanofi’s U300 insulin glargine. Due to the higher concentration it has a longer life, as I described when it was added to the PBS in 2018.

A note about “SoloStar”

Some people (including doctors) have been very confused about this.

SoloStar is not a type of insulin!

SoloStar is Sanofi’s name for their disposable insulin pen cartridges. Just like Novo have their FlexPen and FlexTouch pens for various insulins, and Lilly have their KwikPen for Humalog and Basaglar.

Apidra (a quick-acting insulin) is available in Apidra SoloStar format.
There’s also Lantus SoloStar, and Toujeo SoloStar.

As as aside, I do know a story of one mistake where a doctor charted “SoloStar” for a hospital patient, and Apidra SoloStar was the first one that came up on the computer. It was only realised when the injection of an “evening dose” of >20U of Apidra was being administered. Luckily a medical crisis was averted, but it highlights the need for caution: SoloStar is not the name of an insulin!

Optisulin

Now Sanofi has introduced their Optisulin U100 insulin glargine. In their words:

OPTISULIN® is the same formulation as LANTUS® from the maker of LANTUS® and is available in the same familiar presentation and devices, including the SoloStar® pre-filled device and cartridges for use in either AllStar Pro® and JuniorStar® reusable pens.

Lantus is going away

Optisulin was listed on the Australian PBS as of the 1st of January 2020. And Lantus will be delisted from the PBS as of the 1st of July 2020. Prescriptions for Lantus will still work as it’s just a pharmacy substitution, but presumably prescriptions will start to be written for Optisulin instead.

Sanofi does say:

It requires no dose adjustment when transitioning from LANTUS® and patients transitioning to OPTISULIN® should continue to administer their dose at the same time of day and monitor their blood glucose levels as directed.

[…]

However, close blood glucose monitoring is recommended for all patients during the transition from LANTUS® to an alternative insulin glargine 100 units/mL and in the initial weeks thereafter.

No-one’s expecting any complications from changing to Optisulin, but as with any change to your treatment routine, monitoring is important!

Why the change?

I’m sure Sanofi has been under pricing pressure to reduce how much they charge the government for Lantus, especially with the availability of third-party versions. A cynic could point out that by rebranding the product they get to do this without actually dropping the price of Lantus. But I’m sure that’s a very simplistic point of view…

Packaging

It was easy to distinguish Lantus and Toujeo even though they are both available in SoloStar pen format.

Lantus used a purple button and label edge (and purple on the tips of cartridges for refillable pens).
Toujeo has a light-green button and label edge.

Just to mix things up a bit, Optisulin pens seem to have a purple button and light-green label edge.  Concentrate on the button colour and you shouldn’t get confused.

I don’t yet know what colour the cartridge tips will be.

17 thoughts on “Lantus is being replaced”

  1. Thank you David fir this update. So the same problems with Lantus will remain – perhaps the manufacturers thought they could deceive people with a name change? Please look up ‘Lantus: Lethal or Saviour ?’ to read what i am referring to. Why this info is not on warning labels for it and other brands of the same insulin beats me !!

  2. Wow. What a truly dumb name for a pen system, ‘SoloStar’, and what a stupid colour system that has a clear pattern — label and button colour as the indicator — and then two different colours on the new ‘Optisulin’ pen.

    I truly truly hope that the renaming isn’t simply so the drug maker can exploit some PBS pricing loophole. It’s a bit hard to understand why a drug maker would rebrand a very long established drug though. Surely they can’t truly believe doctors are going to prescribe more Lantus because of the brand name change?

      1. Elaine McAllister

        David, my Dr told me today that Lantus was being replaced, but didn’t say the new insulin wouldn’t be on the Aussie PBS – do you know if it is or not? Thanks ?

  3. Just got my script filled the tip is purple, same as Lantus, just a different colour label, everything else is the same.

  4. Since my daughter started this new optisulin long acting insulin her morning readings are much highter ,her old one was the Lantus and she saying to me it doesn’t work like the Lantus does. Suppose to be exactly the same thing I told her , she will have a few more extra units tonight and see how she Is in the morning.

    1. My husband had the same problem it wasn’t working the same & he had a lot of higher readings with no other changes…. I found 1 left over Lantus pen which he used for a day & a half & readings went back down….. something is definitely different. Has now changed to Tourjo

  5. Yes I’m a Type 1 also experiencing the same problem ie higher levels in the morning after not even having a full dinner and exercising 30 minutes daily and higher levels before evening dose, therefore needing to top up with Humalog(short acting). With Lantus , I didn’t have this problem so suspecting something has changed in the formulation.

    1. Oh wow. No, definitely not!

      Ryzodeg is a mixture that’s effectively 30% Novorapid and 70% Tresiba. You might not know of Tresiba (insulin degludec) because it’s not sold in standalone form in Australia. Like Toujeo it has a very long action, but the 30% of short-acting insulin you get whenever you inject Ryzodeg needs to be matched with a meal so you don’t go low.

      Some people use Ryzodeg around one meal a day, and use Novorapid for the other meals. But even so that fixed mixture can make things very tricky to manage.

  6. I have done nothing but itch and scratch since the swap from lantus to optisulin. I missed injecting this morning and the itching has decreased. No way is it the same as lantus!
    Can’t find the ingredients to compare the 2. But give me Lantus back please

  7. My husbands sugar levels have been totally out of control since he’s had to change to Optisulin. There has to be a difference, every day his levels are higher and higher.

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