Inhaled Insulin

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It was proclaimed “one of the most expensive failures in pharma history,” achieving a tiny fraction of its expected sales and ultimately costing Pfizer $2.8 billion in losses. Exubera, the first inhalable insulin to reach the market, was discontinued in 2007, less than two years after its debut. It was plagued by a bulky inhaler device, confusing units of powder measurement, and concerns about its long-term safety and effect on lung function. But after this colossal flop, a new company is intent on giving inhaled insulin another chance.

A recent article from HealthDay profiles Afrezza, an inhalable insulin manufactured by MannKind Corp. that is awaiting approval for marketing by the US Food and Drug Administration (FDA). Afrezza, according to an executive at MannKind, is absorbed into the blood from the lungs through a new chemical mechanism, different from how Exubera was absorbed. As a result, it works very quickly, peaking in action 12–15 minutes after inhalation, compared with Exubera’s 45–60 minutes. This fast action could let users calibrate their insulin doses more closely to their meals, enabling quick adjustments if blood glucose remains high after the first mealtime insulin dose. It could also lessen the risk of hypoglycemia, since the insulin would not continue to lower blood glucose for very long after a meal.

But concerns about inhaled insulin remain, including those stemming from a higher rate of lung cancer linked to Exubera after its phasing-out had begun. In response, MannKind touts a study of Afrezza in rats that showed no increase in lung cancer risk — but as with any new drug, the long-term risks in humans remain unknown.

What do you think — if you take insulin, would you be interested in switching to an inhaled delivery system? Would you be willing to pay more for inhaled insulin? Does avoiding injections strike you as an attractive feature of inhaled insulin, or does the burden of injections tend to be exaggerated? Do you think a faster-acting mealtime insulin would be helpful? Leave a comment below!

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