Sanofi's inhalable insulin Afrezza new hope for diabetes treatment

Susanna Sisson's picture
Afrezza for diabetes treatment

Early in 2015, it was announced that the world’s first viable, inhalable form of insulin, Afrezza, was about to hit the market. Another similar drug, Exubera, marketed by Pfizer in 2005, failed in marketplace showing as well as efficacy due to the enormous size of the delivery device, and was taken off the market within two years.

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According to the manufacturer, Mannkind who teamed up with French pharmaceutical giant Sanofi to produce Afrezza, the drug has many benefits over current available hyperglycemic drug options.

Pros of Afrezza
• Approved for both Type 1 and 2 diabetics.
• No needles – Afrezza is powdered insulin that dissolves immediately when inhaled into the lungs, and is then quickly dumped into the bloodstream to start working. The drug is delivered via a tiny inhaler device rather than the standard insulin pen or pump that is meant to be disposed of after 15 days.
• Convenient – The device, called the Dreamboat, is about the size of a human finger thus easy to carry in purse or pocket. Afrezza is available as 4 unit and 8 unit single-use cartridges. Three cartridges are contained in a single cavity of a blister strip. Each card contains 5 blister strips separated by perforations for a total of 15 cartridges. Two cards of the same cartridge strength are packaged in a foil laminate overwrap (30 cartridges per foil package). The perforation allows users to remove a single strip containing 3 cartridges, which can be carried in a pocket or a purse. The company is planning new sizes of the drug in 9 and 12 unit cartridges.[4]
• Rapid acting – Afrezza enters the bloodstream faster than Humalog insulin and has a shorter half-life so it is able to counteract the peak blood level spike of glucose from carbs and is out of the system rapidly enough to prevent lingering low blood sugar levels.
• Reduces hypoglycemic episodes – While doctors and proponents of Afrezza say it does reduce incidence of post-prandial (post meal) episodes of low blood sugar, the FDA would not allow that to be part of the product usage labeling.
• Tighter control - Afrezza can be used after a larger meal to lower blood sugar and bring down highs quickly without the risk of stacking insulin.
• Less weight gain – While some diabetes medications cause weight gain, Afrezza does not appear to have that side effect.
• No munchies – with better blood sugar control, there are fewer episodes of blood sugar drop and the hunger that goes with which may also account for less weight gain.

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Cons of Afrezza
• Not a stand-alone insulin therapy and does not replace other hyperglycemic drugs such as injectable insulin. Afrezza is intended for pre-prandial use and post-prandial spikes.
• Contraindicated for patients with any lung disorder such as COPD or asthma or for smokers.
• Not approved for pediatric patients, yet, but the company is seeking FDA approval for pediatric use.
• Not covered by some insurance plans so be sure to check your policy.

Afrezza is fairly also cost effective and comparable to injectable insulin. Walgreen quoted a cost of $334 out-of-pocket cash price for a box of 30 4-unit cartridges or 60 of the 8-unit cartridges.
Insurance companies that currently pay 50% of patient’s insulin costs also cover Afrezza, so, the price would be $130.80 for a box of 60 of the 4-units that should last a month. That is comparable to current insulin prices – and even potentially a bit less than what many pay for a month's worth of Humalog or Novolog.

Resources:
1. http://www.mannkindcorp.com/
2. http://www.webmd.com/diabetes/news/20140630/inhaled-insulin-afrezza?page=3
3. http://www.healthline.com/diabetesmine/welcome-afrezza-inhaled-insulin-gets-real#4
4. http://www.healthline.com/diabetesmine/holding-our-breath-for-inhaled-insulin-afrezza

IMPORTANT SAFETY INFORMATION FOR AFREZZA® (INSULIN HUMAN) INHALATION POWDER
WARNING: RISK OF SUDDEN LUNG PROBLEMS (BRONCHOSPASM) IN PATIENTS WITH LONG-TERM (CHRONIC) LUNG DISEASE
Sudden lung problems (acute bronchospasm) have been seen in patients with asthma and COPD (chronic obstructive pulmonary disease) using Afrezza®.
Afrezza® is not to be used in patients with long-term lung disease such as asthma or COPD.

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Comments

"Insurance companies that currently pay 50% of patient’s insulin costs also cover Afrezza..."??? Could you name some? Practically every plan I looked at has afrezza, IF it's covered at all, listed as tier 3 and requiring prior approval and/or step therapy.