EXUBERA: The Insulin That Does Not Require Injection

EXUBERA

Dry powder formula that can be aerosolized
Comes in 1 mg and 3 mg blisters

1 mg blister = 3 units insulin
3 mg blister = 8 units insulin

Onset of action: 12 min - 24 min.
Duration of action: 4 - 6 hrs.
Cons

Apparatus is bulky and may deter people from trying inhaled insulin
Dosing is not as flexible as with injections
Combinations are only with 1 and 3 mg packets
No long term data is yet available
Need trials in those with lung disease to see effects
Cost may be a big issue- as of now, price has not been determined

SUMMARY

Incidence of DM is increasing from year to year
Tight glycemic control is needed to prevent complications of DM
In addition to glycemic control with medications, diet and exercise play key roles in controlling DM
In those with NIDDM, more people may need to be transitioned to insulin therapy to gain better glycemic control
In NIDDM, many patients are afraid of converting over to insulin therapy when oral medications are ineffective
As a result, many physicians are reluctant to initiate insulin therapy to their patients when oral medications aren’t working
Exubera offers a satisfactory and effective alternative by removing the injection aspect out of insulin administration
In NIDDM, many patients are afraid of converting over to insulin therapy when oral medications are ineffective
As a result, many physicians are reluctant to initiate insulin therapy to their patients when oral medications aren’t working
Exubera offers a satisfactory and effective alternative by removing the injection aspect out of insulin administration

NEW TREATMENTS BEING DEVELOPED

Dry powder insulin

Exubera
HIIP
Spiros
Microdose DPI
Technosphere

Liquid aerosol insulin

AERx iDMS
Aerodose
Alveair

Coated dry particles

Bio-air

Dry crystals

REFERENCES

Cefalu, William, et al. Inhaled Human Insulin Treatment in Patients with Type 2 Diabetes Mellitus. Annals of Internal Medicine 2001; 134:203-207.

DeFronzo, Ralph, et al. Efficacy of Inhaled Insulin in Patients with Type 2 Diabetes not Controlled with Diet and Exercise. Diabetes Care 2005; 28:1922-1928.

Galan, B.E., et al. Efficacy and Safety of Inhaled Insulin in the Treatment of Diabetes Mellitus. Netherlands Journal of Medicine 2006; 64:319-325.

Hollander, Priscilla, et al. Efficacy and Safety of Inhaled Insulin (Exubera) Compared with Subcutaneous Insulin Therapy in Patients with Type 2 Diabetes. Diabetes Care 2004; 27:2356-2362.

Rave, Klaus, et al. Time-Action Profile of Inhaled Insulin in Comparison with Subcutaneously Injected Insulin Lispro and Regular Human Insulin. Diabetes Care 2005; 28:1077-1082.

Rosenstock, Julio, et al. Inhaled Insulin Imporves Glycemic Control When Substituted for or Added to Oral Combination Therapy in Type 2 Diabetes. Annals of Internal Medicine 2005; 143:549-558.

Rosenstock, Julio, et al. Patient Satisfaction and Glycemic Control after 1 year With Inhaled Insulin (Exubera) in Patients with Type 1 or Type 2 Diabetes 2004; 27:1318-1323.

White, Steven, et al. Exuber: Pharmaceutical Development of a Novel Product for Pulmonary Delivery of Insulin. Diabetes Technology & Therapeutics 2005; 7:896-906.