By Jordan Rand, Pharmacy Student, Northeastern University
New treatment options that come on the market are often met with great anticipation. In the case of Afrezza, the inhaled insulin approved by the FDA in June, the potential of utilizing a different route of administration is intriguing. With the prevalence of the disease, innovation in insulin delivery can affect many.
Afrezza is a rapid-acting inhaled insulin that is comprised of recombinant human insulin in a dry powder, which when inhaled, is rapidly absorbed upon contact with the surface of the lung. The device is approximately the size of a referee’s whistle, and takes 4 unit and 8 unit cartridges containing the aerosolized insulin. Doses are rounded up to the nearest 4-unit interval, in consideration of the route of administration having inefficient absorption.
In patients with type 1 diabetes, Afrezza was compared to insulin aspart, both in combination with long-acting insulin, and was found to be non-inferior to the injection-only regimen in regards to A1C reduction. In patients with type 2 diabetes, inhaled insulin plus glargine was shown to have a similar reduction in A1C when compared to premixed insulin.
Inhaled insulin is not without its disadvantages. The product is contraindicated in patients with chronic lung disease, such as asthma and COPD because acute bronchospasm was observed in patients with asthma and COPD using Afrezza. A detailed medical history, physical examination, and spirometry should be performed before initiation of the medication. The safety and efficacy of Afrezza in those who smoke has not been established, therefore it is not recommended in patients who smoke or recently stopped smoking. An increased incidence of cough was found in one study, occurring in 32% of patients in the Afrezza group compared to 4% in the control group. Diabetic ketoacidosis occurred 4.8 times more frequently in Afrezza-treated patients with type 1 diabetes compared to those treated with subcutaneous insulin. There was no significant difference between inhaled and subcutaneous insulin in regards to hypoglycemia.
Patient satisfaction may lead Afrezza to become a widely used medication, with ease of use, social comfort, convenience, and mealtime flexibility being factors strengthening its claim on the marketplace. In contrast to the only other inhaled insulin brought to market, Afrezza is a small device that seems simple to teach and use. It is anticipated that Afrezza will be available in early 2015.
References
- Pittas A. Inhaled insulin therapy in diabetes mellitus. In: UpToDate, Mulder J (Ed), UpToDate, Waltham, MA. Accessed November 23, 2014.
- Afrezza (insulin human). DrugPoints Summary. Micromedex 2.0. Truven Health Analytics, Inc. Greenwood Village, CO. Accessed November 23, 2014.
- Afrezza [package insert]. Danbury, CT: MannKind Corporation; 2014. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022472lbl.pdf Accessed November 23, 2014.
- FDA. FDA approved Afrezza to treat diabetes, FDA News Release. Silver Spring, MD. Last updated June 30, 2014. Accessed November 23, 2014.