March 21, 2007

Exubera Update

If you'll remember, back when Pfizer launched Exubera, the inhaled insulin, with a lot of press hype, I was interviewed by Business Week as a "typical patient" and I quoted (very vaguely) about why I thought Exubera was a bad idea for people with diabetes.

It looks like I was onto something.

Today the AP is carrying a story about how endocrinologists have proved resistant to Pfizer's push to market this expensive, potentially dangerous form of insulin.

Here's a quote from the article:

" ''I think Pfizer will wish they had never gotten into this. I doubt they'll regain their investment,'' said Dr. John Buse, president-elect of the American Diabetes Association, who participated in Exubera's trials. ''There is no advantage to Exubera and there may be a safety risk. I see it as my job to talk people out of (using) it.'' "

Pfizer's main concern is profits, so they're responding to the refusal of the endocrinologists to prescribe the drug by hiring hundreds of supposed "diabetes educators" to market the drug to general practitioners--doctors with little if any expertise in prescribing insulin, who can, presumably, be more easily talked into putting their patients on the drug.

What's wrong with Exubera you may ask?

1. A good possibility that it causes long-term lung damage. You only have one set of lungs and if you screw them up, life is unpleasant and short.

2. This is a meal time (bolus) insulin but it is dosed by the patient's body weight. So the dosage does not correlate to the grams of carbs in the meal. This makes it impossible for people using it to achieve normal blood sugars.

In contrast, Novolog can be matched very closely to the number of grams of carbohydrate in a meal, as can regular (R) insulin. This makes it possible to achieve completely normal blood sugars using them, especially if you keep carbohydrate amounts low to moderate.

3. Expense. This insulin cost far more than the other insulins on the market.

There are some versions of oral insulin in the testing pipeline that don't need to be inhaled. They may prove to be a better choice for people who are needle-phobic. Unfortunately, the dosing issue may still be a problem with those products. And the very high cost may be an even bigger problem.