Inhaled Insulin is Back

Today I was able to use Afrezza's new demo inhaler. As some may be aware, this is not the first time that inhaled insulin has hit the market. In 2006 the FDA approved an inhaled insulin called Exubera which Pfizer later pulled off the market in 2007. Patients complained about its large size (see image below) and its difficulty of use. In addition to its increased cost without additional proven efficacy, some had concerns about the risk of damage to the lung, and even lung cancer.

Afrezza was approved on June 27, 2014 for the treatment of type I and type II diabetes and is starting to roll out to pharmacies. I had not personally seen it in any pharmacy until today, but it's certainly has some vast improvements over its predecessor. It's a substantially smaller and more discrete device; one patients will feel much more comfortable bringing out in social settings. This may be beneficial for adherence in patients with strong needle phobias. It works similarly to a dry powder inhaler, with 4 and 8 unit delivery devices. Unfortunately, this means many patients will end up having to use multiple cartridges. Per Lexicomp, a unit with 90 4 Unit cartridges will run for approximately $270, with 8 unit and mixed unit packages increasing in price from there. In comparison, Novolog solution runs at about $268. I am not familiar with insurance coverage for Afrezza at this point, so I can't comment on the cost-effectiveness for the patient.

It is important to note that Afrezza cannot be used in patients with asthma or COPD, and has a boxed warning for bronchospasm. I will be interested to see the outcomes of this product over the years, particularly regarding if the same safety concerns that Exubera faced will arise once again.

Afrezza

EXUBERA