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Afrezza® inhaled insulin is approved for diabetes management

Updated: Sep 10


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In the 2nd week of December 2024, the medical fraternity received a piece of heart-warming news about inhaled insulin. Cipla received approval for the distribution and marketing of Afrezza® an inhaled insulin in India. The product created by Mannkind Corporation can be a blessing for millions of Indians who have compliance issues with injectable insulin (1).


About Afrezza®


Afrezza® (inhalable insulin) is a promising, ultra-rapid-acting noninjectable insulin delivery option designed to assist individuals with type 1 and type 2 diabetes, in managing their blood glucose levels (1). 


Afrezza® is administered before meals using a dry-powder inhalation device. The product is formulated with a novel excipient, fumaryl diketopiperazine that dissolves instantly in lung fluid and releases recombinant human insulin for absorption (2).


According to data from clinical trials, Afrezza® appears to be efficacious and comparable to currently available prandial insulin options. It has also been found to be a safe alternative to injectable insulins with high treatment satisfaction (3).


Mechanism of action


Afrezza® is a rapid-acting inhaled insulin. The inhalation powder in Afrezza® is a regular human insulin. The metabolism and elimination of the inhalation powder are comparable to regular human insulin after pulmonary absorption into the systemic circulation. Peak insulin levels are achieved within 12 to 15 minutes after administration (4).


Insulin aids in HbA1c reduction by stimulating peripheral glucose uptake via skeletal muscle and fat and by inhibiting hepatic glucose production. Insulin inhibits lipolysis in adipocytes, inhibits proteolysis, and enhances protein synthesis (4).


Implication of Afrezza® on clinical practice


Afrezza® can be a viable alternative for insulin naïve patients who are hesitant to initiate injectable insulin due to insulin phobia (3). 


Afrezza®  is ultra-rapid-acting insulin with faster pharmacokinetics and pharmacodynamics than the 3 rapid-acting insulins (insulin aspart, insulin glulisine, and insulin lispro) (5).

Compared to subcutaneous mealtime insulin, Afrezza® may cause less weight gain with a more rapid absorption and elimination profile (4). 


Hypoglycemic episodes are significantly lower with Afrezza® compared to traditional injectable insulin products (6). 


The compact hand-held Afrezza® inhaler is non-invasive and relatively easy to use (7).

Afrezza® is not recommended for people with diabetic ketoacidosis and is contraindicated during hypoglycemic episodes (4). 


Clinical evidence


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Adapted from Fala L. Afrezza (Insulin Human) Inhalation Powder Approved for the Treatment of Patients with Type 1 or Type 2 Diabetes. Am Health Drug Benefits. 2015 Mar;8(Spec Feature):40-3 (4).  

Indications


AFREZZA® is a ultra-rapid-acting inhaled insulin indicated to improve glycemic control in adult patients with diabetes mellitus (8).


Afrezza® should be administered in conjunction with long-acting insulin in patients with Type 1 Diabetes (2).


Afrezza®  can be utilized independently or in combination with oral medications or long-acting insulin to assist adults with type 2 diabetes in managing their blood glucose levels before meals (2).


Afrezza®  is not intended as a substitute for normal basal therapy with injectable long-acting insulin but may be used to provide prandial insulin coverage (6).

Dosing and Administration


Afrezza®  is available as single-use cartridges of 4 and 8 units. The inhalation powder is administered at the beginning of a meal using a single inhalation per cartridge. Dosing must be individualized as per patient needs (4). 

Safety


Afrezza® is found to be safer. The most common adverse reactions (≥2%) include hypoglycemia, cough, and throat pain or irritation (4).

Conclusion


Diabetes management is a significant challenge. Uncontrolled blood sugar can lead to both microvascular and macrovascular complications. A plethora of treatment options have significantly improved blood glucose control. The introduction of injectable insulin has changed the landscape of diabetes management improving the lifestyle and quality of life of millions globally. The recent approval of Afrezza® inhalation powder has made available a new treatment option for the treatment of adults with diabetes. The treatment was found to be safe and effective and may help improve treatment compliance in patients who have injection phobia. 


About the Author


Dr. Sheeba Rani is a pharm D graduate currently working as a medical writer providing support with medical communication deliverables. She is passionate about clinical research and medical writing and has a keen interest in understanding novel pharmacotherapeutic agents. Dr. Sheeba also enjoys cooking and spending time outdoors.


Abbreviations


OAD: Oral antidiabetic drugs; Afrezza®: Inhaled Insulin; HbA1c: Haemoglobin A1c; 

Reference


  1. Cipla receives approval for distribution and marketing of inhaled insulin in India. Available at: 

    https://www.cipla.com/press-releases-statements/cipla-receives-approval-distribution-and-marketing-inhaled-insulin-indiaAccessed on 13 December 2024. 

  2. Ledet G, Graves RA, Bostanian LA, et al. A second-generation inhaled insulin for diabetes mellitus. Am J Health Syst Pharm. 2015 Jul 15;72(14):1181-7. 

  3. Fleming LW, Fleming JW, Davis CS. Afrezza: An inhaled approach to insulin delivery. J Am Assoc Nurse Pract. 2015 Oct;27(10):597-601. 

  4. Fala L. Afrezza (Insulin Human) Inhalation Powder Approved for the Treatment of Patients with Type 1 or Type 2 Diabetes. Am Health Drug Benefits. 2015 Mar;8(Spec Feature):40-3.  

  5. Klonoff DC. Afrezza inhaled insulin: the fastest-acting FDA-approved insulin on the market has favorable properties. J Diabetes Sci Technol. 2014 Nov;8(6):1071-3.

  6. Ledet G, Graves RA, Bostanian LA, Mandal TK. A second-generation inhaled insulin for diabetes mellitus. Am J Health Syst Pharm. 2015 Jul 15;72(14):1181-7.

  7. Goldberg T, Wong E. Afrezza (Insulin Human) Inhalation Powder: A New Inhaled Insulin for the Management Of Type-1 or Type-2 Diabetes Mellitus. P T. 2015 Nov;40(11):735-41.

  8. Afrezza Prescribing information. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022472lbl.pdfAccessed on 14 December 2024. 

Disclaimer


The matter published on this platform has been developed by independent medical writers from various healthcare backgrounds including members of MedWriters Alumni Network. Although great care has been taken in compiling and checking the information, the authors, Rxnews team and its partners or agents, and sponsors shall not be responsible or in any way liable for any errors, omissions, or inaccuracies in this blog article whether arising from negligence or otherwise, however or for any consequences arising therefrom. The inclusion and exclusion of any product do not mention that the publisher advocates or rejects its use generally or in any particular field or field. For any complaints or feedback please write to content@rxnews.in

 

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