The diabetic nephropathy (DN) market is complex, because in addition to specific mechanisms that directly impact the disease, blood pressure and glycemic control are other general targets that affect the condition. Moreover, there is high cardiovascular (CV) risk in DN patients, and many physicians may be more concerned about that than the risk for end-stage renal disease, especially in less advanced patients. Hence, drugs that directly impact DN and also benefit these other targets or have a CV benefit can have a competitive advantage. 

The SGLT-2 inhibitors are renewing the genericized market due to their renal and CV benefits in DN patients. Along with Bayer’s non-steroidal mineralocorticoid receptor antagonist (MRA) Kerendia (finerenone), and now also Novo Nordisk’s GLP-1 Ozempic (semaglutide), they are expected to continue to grow the market in the intermediate term, with sales growth slowing in 2026, and then revenues eventually declining as the class loses patent protection. New laws in the US targeting the pricing of high-expenditure products could also impact their growth.