Afrezza image

Inhaled insulin one step closer to approval

pharmafile | April 3, 2014 | News story | Sales and Marketing Afrezza, FDA, Mannkind, diabetes, type 1, type 2 

After a rocky few years MannKind’s inhaled insulin Afrezza finally looks to be on the path to approval in the US.

This comes after a key FDA advisory committee voted to recommend its inhalation powder drug Afrezza (insulin human [rDNA origin]) be granted marketing approval.

If approved, Afrezza would be the first ‘ultra-rapid-acting’ mealtime insulin therapy available in the US, for both type 1 and type 2 diabetes sufferers.

“We are pleased with the advisory committee’s approval recommendation in support of Afrezza, and we appreciate the thoroughness of their review,” says Alfred Mann, chairman and chief executive of MannKind.

 “We look forward to working with the FDA as they complete their evaluation of Afrezza. Diabetes is a major health problem in the US, and we are committed to bring Afrezza to the many patients who might benefit from this novel product.”

It has not been an easy road for the firm, however. MannKind’s initial license application for Afrezza was turned down by the FDA in 2011. The regulator told the firm that additional clinical trials would need to be conducted before it would look again at approving the drug.

These trials included a treatment group using the previously studied MedTone inhaler, in order to obtain a head-to-head comparison of the pulmonary safety data for the two devices.

And in August last year these studies came out positive for MannKind after meeting their primary endpoints, paving the way for a potential approval.

The FDA is not bound by the advisory committee’s recommendation but will consider its guidance in reviewing the new drug application for MannKind’s treatment. The decision should be made by the agency on 15 April.

The drug is an ultra-rapid-acting mealtime insulin designed to improve glycaemic (sugar) control in patients with type 1 or type 2 diabetes.

It is a drug-device combination product, consisting of Afrezza inhalation powder delivered using an inhaler. The powder dissolves immediately upon inhalation into the lungs and the delivers insulin into the bloodstream in around 12 to 15 minutes.

This is compared to the 45 to 90 minutes for injected rapid acting insulin analogs and 90 to 150 minutes for injected regular human insulin, according to the firm.

Holy Grail

Inhaled insulin was once seen as the Holy Grail for pharma, but has been met with much difficulty since.

Pfizer’s Exubera (insulin human [rDNA origin]) inhalation powder was the first such treatment to reach the market, but was later withdrawn in mid-2007 after it failed to catch on with doctors.

Lilly’s AIR insulin product suffered a similar setback in 2008 when it cancelled Phase III trials of its drug due to the “increasing uncertainties in the regulatory environment”, which looked to be the end of inhaled insulin.

MannKind has however remained dedicated to producing an inhaled insulin product, and even acquired Pfizer’s Exubera manufacturing facility, and has remained confident that Afrezza will make it to market.

Ben Adams 

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