Fate of the inhalable insulin 'Afrezza'

Originally Published in THE WEEK 

With the dread, discomfort and pain involved with the usage of the injectable insulin for a diabetes patient, an inhalational form is indeed a boon. With the first inhalable insulin called ‘Exubera’ being marketed by Pfizer in the year 2006, one would have expected that a new delivery system of insulin would bypass the constant need for a needle and syringe, to gain immediate widespread popularity amongst the diabetic population. But this failed to happen. No more than a year into its release Pfizer decided to stop the production and marketing of Exubera. Other companies that were also involved the research and development of their own form for inhalable insulin too stopped their research following Pfizer’s withdrawal.

      In the year 2014 FDA approved a new inhalable insulin developed by Mannkind and its marketing partner for the same being Sanofi. Following its approval the drug hit the US markets in 2015 but is claimed to have suffered heavy losses as of till date, even before the drug could hit the world markets. Due to this the marketing partner for Afrezza, Sanofi has pulled of its agreement with Mannkind early this year, citing the same problem that Pfizer faced with their product Exubera which was lack of popularity and profit. Mannkind has assured that despite this the drug will still continue to be available in the market.

      Clinically Afrezza has shown great promise with no drawbacks as compared to injectable insulin. It can be used for immediate reduction of blood glucose such as that required by diabetics postprandially (after meals). It is not an alternative for long acting insulin and Patients who are smokers or are having any lung disorders such as COPD or asthma should avoid using Afrezza. Compared to rapid acting insulin it is slightly inferior to its glucose lowering ability but has a lower incidence of hypoglycemic episodes as compared to the same. Also its kinetics is fastest as compared to other forms of insulin. The device used to deliver the powder is the size of a whistle and the patient can comfortably use it in public without the physical and mental discomfort they would otherwise face whilst using a form of injectable insulin. The device is used with a cartage that contains the inhalable insulin powder with is available in 4, 8 and 12 units. The delivery system is effective for reduction in number of injections required by most patients if not in eliminating the need for the same altogether.

     Diabetics throughout USA have demonstrated their disappoint on social media and on online forums regarding their fears that the production of Afrezza might come to an end while also expressing their satisfaction with the product. “So disheartened to see that @sanofi dropped #Afrezza. This drug has made managing my daily life 10x easier and I can't go back. #t1diabetes”, claimed one user on twitter.

     Finding an alternative for injectable insulin has probably crossed every drug developers mind at some point, with the clinical success of Afrezza which is a fast acting insulin approved for both Type 1 and Type 2 diabetes mellitus in adults, it would be a shame if this drug does not make it to the global market and gets withdrawn just like Exubera or like one doctor put it, it would just be good science and nothing more.

----Raghuvir Keni