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Inhaled Insulin Strikes (Out) Again

The Wall Street Journal has a good post-mortem of Sanofi’s inhaled insulin experience with Mannkind. I was puzzled by that deal when it was announced, because I’d had a long history of being puzzled by Mannkind and their product (not to mention by their investors, who are a breed apart). Well, they were, anyway – I wonder how many of them are still hanging in there, taking the stage yet again in a long-running production of The Righteous Shareholders Confront the Evil Short Bashers.

Despite the industrywide retreat from inhaled insulin, former Sanofi CEO Christopher Viehbacher believed the advantages of inhaled insulin—speedier delivery to the bloodstream and a reduced dependence on needles—meant it was still worth a bet. In 2014, he agreed to pay MannKind up to $925 million, mostly in milestone payments, for the rights to market the recently approved Afrezza. By ending the agreement when it did, Sanofi capped its 2015 losses at roughly €200 million, according to the company.

A pittance, I’m sure. As the article goes on to say, one big problem was that no data were ever produced to indicate that Afrezza was any better than injectable insulin, which left the pitch at “avoid the needle”. And that really doesn’t seem to be enough, especially with hard-to-shake worries about lung effects in the long term. The pricing (and the insurance status, Tier III) of the product didn’t help, either. That seems to be what the company is holding out hope for. Mannkind says that they have enough cash to make it into the second half of the year (November? July?), and are hoping to make a new deal with someone who would like to see the product achieve minimal market penetration at an even lower price point. Well, no, that’s not what they’re saying, but that’s what’s most likely to happen, assuming that they can find anyone willing to try it.

11 comments on “Inhaled Insulin Strikes (Out) Again”

  1. Chemist turned banker says:

    You are right about Mannkind’s investors, a motley crew who make The Donald look as excitable as an actuary….

    I always thought inhaled insulin missed the point- pen injections are virtually painless, finger prick blood tests are not. Let’s hope the work on noninvasive Raman spectroscopy to measure blood glucose comes to something

    1. Mark Thorson says:

      Maybe this new device will solve the problem.

      http://www.dailymail.co.uk/health/article-3440404

      1. Slow Joe Crow says:

        This Freestyle Libre seems like an incremental improvement on the Dexcom that is very common the US. After 18 months with a Dexcom and a 12 year old girl with T1, I can say that the technology is good but not great. The trending information and the early alerting of a glucose monitor is good but the Dexcom can be up to 40 mg/dl off from a glucose meter so it is far from a panacea.
        As somebody who lives this stuff daily, an inhaler seems pointless compared to a pen or pump system. “smart insulin” which hangs a control mechanism off an insulin molecule or automation based on a better CGM, an insulin pump and glucagon to control lows are far more promising and interesting.

      2. SedatedFMS says:

        Sorry fella, but quoting the Daily Fail “news”paper, nae’mind their health section is akin to using Naturalnews or Mercola dot com as a primary source of information.

  2. Anonymous Researcher snaw says:

    I think Chemist turned banker is right: injecting insulin isn’t the hard part of managing insulin-dependent diabetes. Monitoring blood sugar levels is the big challenge and we need easier ways to do that.

    1. Gretchen says:

      The benefit of Afrezza is not that it doesn’t have to be injected. I’d rather inject than risk lung damage. The benefit is that it works very quickly, and some people who understand how it works are getting good results. The average patient may not. Time will tell.

      1. diabetic chemist says:

        That’s the key point. We have the technology today to control BG extremely well. If one is willing to learn how it all works and make the effort near normal A1c levels are possible. The trouble is it’s a pain in the ass (somewhat literally) and most diabetics don’t go as far as they could. If you could make the monitoring easier, they/we would do better.

        Although I’m not as up on the literature as I ought to be (denial is a hell of a drug), the last time I checked, slightly elevated A1c levels (by which I mean very slight – 6.5ish) didn’t pose much of a long term risk. That is, taking your A1c from 6.5 to 5.8 is really hard and doesn’t really buy you much in the way of overall health benefits. If that isn’t true, I’m happy to be corrected but it has guided my regimen.

        I can say that when I was diagnosed in the early 80s no one expected I’d be sitting here with no complications, in good health, in 2016. I’d give a lot for a really accurate continual BG monitor. Other advances are welcomed but I can well imagine living the rest of my life as is.

  3. Dave says:

    So, if inhaled Insulin isn’t really a good idea, how about Insulin absorbed through the skin? An Insulin-patch, perhaps? (No, I don’t have all of the details worked out, else I’d be standing in line at the Patent Office/FDA.). This might be of more use to Insulin-dependent Type-2s, rather than Type-1s, though (Insulin-analogues?).

    1. Mark Thorson says:

      Unlikely. Insulin is a big molecule, difficult or impossible to get through the skin. And, it would be slow. A benefit of Afreeza is that it is fast.

      1. Mark Thorson says:

        I got to thinking that maybe sublingual (under the tongue) might work. That’s been looked at.

        http://www.ncbi.nlm.nih.gov/pubmed/3275772

        Possibility, but intranasal or rectal is better. Other people have mentioned that injecting insulin isn’t the bad part. I’m not sure taking it up the butt is an improvement over that. Snorting it might not be bad. Maybe we could add another drug so you’d look forward to your next line of insulin . . .

  4. PorkPieHat says:

    Check out the latest Fierce Pharma story on the MannKind :
    http://www.fiercepharma.com/story/sanofi-tried-and-failed-afrezza-why-does-mannkind-still-think-it-can-win/2016-02-10

    As with this blog, the comments are every bit (and more) as compelling as the article.

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