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Synopsys Inc. Message Board

lakers_w 225 posts  |  Last Activity: Aug 26, 2015 10:15 AM Member since: Jun 13, 2000
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  • Laureen (@Reen910) tweeted at 3:42pm - 23 Jul 15:

    Called Caremark to get preauth for Afrezza and nice rep was interested. Aft I explained she's asking her doc #Afrezza #afrezzaadvocateS

  • Check from MMIT apps, Afrezza, NewYork, Commercials
    Hundreds of Cos such as AFLAC, Unions in NY covers Afrezza via Express Scripts PBM Tier 3, No PA (Prior Authorization), ST (Step Therapy) restrictions. Matt said Exubera initial sales was better than Afrezza due to No PA required and earlier DTC Ads.

  • lakers_w lakers_w Jul 24, 2015 12:21 PM Flag

    A No cancer result could remove or mitigate the worst part of Afrezza label. The Hypo risk will also be removed after Superiority trials complete in Jan 2016. Good label and improved mkt access would give Sny Medical Affairs more ammo to persuade Docs at dinner seminars.

  • lakers_w lakers_w Jul 24, 2015 12:14 PM Flag

    Anthem Blue Cross GenRx, CA, Preferred, Approved
    BC CA RightPlan PPO 40 Generic, Preferred, Approved
    By MMIT

  • Reuters) - Anthem Inc said on Friday it would buy Cigna Corp in a deal valued at $54.2 billion, creating the largest U.S. health insurer by membership.

    The deal — the biggest ever in the health insurance industry — comes three weeks after Aetna Inc agreed to buy Humana Inc for $37 billion and is part of an industry-wide consolidation following the roll-out of President Barack Obama's healthcare law.

    Antitrust authorities are expected to aggressively scrutinize how the combinations will affect competition for Medicare and individual and commercial insurance.

    By most measures, U.S. insurance markets are extremely concentrated. That means companies could have trouble selling assets if forced to do so by antitrust regulators.

    Anthem said it expects the deal to close in the second half of 2016, indicating a long regulatory road ahead.

    Anthem and Cigna are two of just four major insurers that administer self-insured plans for major companies. The other two are UnitedHealth Group Inc and Aetna.

    UnitedHealth is currently the biggest U.S. health insurer by membership, while Anthem and Cigna rank No. 2 and No. 4.

    "When you go from four to three national players, that creates a significant issue," said Matthew Cantor of law firm Constantine Cannon LLP.

    Anthem said it was confident it would get all necessary regulatory and other approvals.

    The combined company would have about 53 million members.

    UnitedHealth had 45.86 million members as of June 30.

    Growing concerns about market concentration came into sharp focus earlier this year when regulatory concerns scuttled Comcast Corp's $45 billion bid for Time Warner Cable Inc.

    LOWER COSTS

    Anthem said it will pay $103.40 in cash and 0.5152 of its shares for every Cigna share.

    The deal is valued at $183.36 per share based on Anthem's Thursday close of $155.21.

    Cigna shares were up 0.2 percent at $154.68 in premarket trading, while Anthem shares were up 0.5 percent at $156.06.

    The equity portion of the offer is valued at $49.11 billion, according to Reuters calculations based on 261.2 million Cigna shares outstanding as of March 31.

    Anthem said the offer is valued at $188 per share, based on its unaffected share price as of May 28 before reports that the two companies were in talks.

    The company has said the acquisition will help it reduce costs and allow it to negotiate lower prices with doctors and hospitals.

    The combined company will be led by Anthem Chief Executive Joseph Swedish. Cigna Chief Executive David Cordani will be president and chief operating officer.

    Anthem's lead financial adviser is UBS Investment Bank. Credit Suisse also served as financial adviser, and White & Case LLP as legal adviser.

    Morgan Stanley is Cigna's financial adviser and Cravath, Swaine & Moore LLP its legal adviser.

  • lakers_w lakers_w Jul 24, 2015 2:42 AM Flag

    I didn't realize that one of the biggest impediment to Afrezza adoption is fear of lung cancer until I visited my PCP for a severe cold. I asked him if he prescribed Afrezza. He said he used to prescribe Exubera for needle phobics. He had degree in PharmD, MD, and Eastern medicine Dr as well. He wouldn't prescribe unless needle phobic PWD demand it as lung cancer is a big risk. I argued Al said Mnkd has X-ray'ed 5-yr non-smoking users. There was no sign of lung cancer. My PCP replied 5 yrs is not long enough. It may take 10 yrs or more to develop lung cancer from foreign substance. I didn't have any answer for that. He said many of his peers heard about Afrezza efficacy. However, they wouldn't prescribe it due to long term cancer concerns unless needle phobic PWDs demand it or a 20-yr FDA trial conclusively determines that lung cancer is not an issue. This couples with market access really kill this stock. That's why this trial is so monumentally important.

    This data will be very interesting but still inaccurate as just an Afrezza study because the patients will have probably about 2 years of Exubera use before the 6 years of Afrezza. Anyways, still a study of nearly 8 years of inhaling insulin. This would still be worth something to look at how this "long term" use affected these patients.

  • lakers_w lakers_w Jul 24, 2015 2:16 AM Flag

    Further study details as provided by Mannkind Corporation:

    Primary Outcome Measures:
    The main objective of this trial is to monitor safety outcomes and collect safety information on TI Inhalation Powder in subjects whose treatment has been converted from Exubera to TI Inhalation Powder. [ Time Frame: 72 months ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Safety variables monitored will include all adverse events (AEs)and serious adverse events (SAEs)- throughout trial duration [ Time Frame: 72 months ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Physical examination findings [ Time Frame: Every 6 months ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Clinical laboratory tests [ Time Frame: Every 6 months ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Chest x-rays [ Time Frame: Annually ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Pulmonary Function Tests - spirometry (FEV1, FVC and FEV1/FVC) [ Time Frame: Every six months up to month 60 then annually ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Pulmonary Function Tests- DLco [ Time Frame: Every six months up to month 60 ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Pulmonary Function Tests - TLC [ Time Frame: Every six months up to month 60 ] [ Designated as safety issue: No ]
    Data will be analyzed utilizing a listing with descriptive statistics, where applicable

    Enrollment: 16
    Study Start Date: October 2008
    Study Completion Date: May 2015
    Primary Completion Date:

  • My big question is why is this stock so embattled!? Is this a common phenomenon for most new drugs and their life through trials, FDA approval, and Launch?

    I believe this is why. It is because this drug is inhaled. Maybe this is obvious but I rarely see it talked about as a very strong psychological deterrent for people trying it.

    For the past 50+ years the push to get people to stop smoking has been one of the largest and longest public health battles in America. With so many loved ones dying of lung cancer I remember as a kid all the talk about puffing on anything was going to give you cancer! It was, and today, still is drilled into our heads, and our kids heads.

    Now comes along something that you inhale that can help you tremendously! I feel those that are hardcore lung purists believe with such conviction that the lungs are the untouchable entry way into our bodies and should forever remain that way. I feel they are strongly against it as if it was some sort of religion.

    Now for some reason inhalable medicine that is "for the lungs" like abuterol, Spiriva or numerous asthma medicines get a free pass. I don't know why but they just do. Of course inhalable asthma medicines have been used for 50 years now without any signs of increasing cancer so we know you can administer medications daily long term in the lungs without significant side affects.

    I know it's the "growth hormone" factor of insulin that some people worry about, and what the long term use affects are. I guess the true long term affects have to be eventually played out to get the answer for those who are doubters of the benefits of Afrezza.

    I believe for these reasons, American diabetics are scared to inhale something as medicine because they have been inundated with the rule that you inhale nothing into your lungs but clean air. I also believe that Europeans an most international potential users of Afrezza will be a lot less afraid to try Afrezza and when approved, these sales will climb fast.

    Have you heard of the FDA safety study that was done on a handful of Exubera users that got to transition to Technosphere insulin "Afrezza" because of extreme needle fear. There was a study that the FDA just wrapped up in May on these patients that used inhalable insulin for 6 or more years! I would love to know when the reports on this come out!? I know the results will be claimed insignificant because the study is only with 16 participants but it is still a long term study on people inhaling insulin just the same. here is the link:

  • lakers_w lakers_w Jul 23, 2015 12:51 PM Flag

    How much do you value MC and MT separately with myriad of APIs? George Rho suggested a spin off. MC is worth $40/sh. MT? Will find out in 4Q15.

  • From Lantus to Afrezza?

    Like all Big Pharma, Sanofi has suffered from patent expirations which have forced the company to cut prices in order to remain competitive. The company's blockbuster insulin drug Lantus, for example, was the world's most prescribed insulin drug in 2014 and produced a total sales of $7.2 billion that year. With Lantus now off patent, Diabetes sales have declined by 3.2%. While the expiration of the Lantus patent has undoubtedly decreased sales, the company has offset much of these costs via the development and commercialization of new products.

    In fact, overall net sales rose by 4.9% in 2014 despite declining sales in Diabetes. As aforementioned, the growth was due to the strong performance of Genzyme's Fabrazyme and Aubagio. SNY's new diabetes drug Toujeo will further offset the decline in Diabetes sales. Toujeo is a once-daily long-acting basal insulin which was approved by the FDA and the European regulatory authorities in February, 2015. Likewise, Lyxumia (Diabetes) is now available in various countries, including Japan, Spain, Italy and Mexico. Both drugs are expected to support Diabetes sales in 2016.

    Of greatest promise, however, is the potential of Mannkind's (NASDAQ:MNKD) Afrezza which was approved in February 2015. Afrezza is a rapid-acting inhaled insulin which improved glycemic control in adult patients with diabetes. Despite the fact that many patients have praised Afrezza since its launch, Afrezza sales are far from impressive at this time. But, as I have previously argued, this is a mere talking point for bears. Initial sales reports are far from an adequate indicator of the drugs long-term potential. As MannKind's CFO recently remarked,"The strategy here is targeted and focused, and that's important because we need to educate the specialists and high-prescribing physicians for appropriate usage of their medicine."

    Indeed, the problem with Afrezza is not product-based; rather, it is a matter of commercialization. Introduced to the market with absolutely no advertising, Afrezza sales have remained low due simply to a lack of name recognition. In fact, a recent survey conducted by Jeffries' Shaunak Deepak found that 35% of sampled doctors were entirely unaware of the drug's existence. In order to address this problem, Sanofi and MannKind plan to launch major advertising efforts, including a recently launched education program for patients using Afrezza. As patients and doctors learn more about the treatment, I believe that sales stand to increase substantially.

  • lakers_w lakers_w Jul 21, 2015 10:33 PM Flag

    Simple logic. Matt didn't expect Afrezza to become profitable until 2017. Meanwhile they indicate a willingness to spend big bucks to develop TS pipeline and become a drug RnD power house. How do they come up with billions and pay off Notes given low cash balance? You can't have it both ways. They have to sell their test vehicle first. Sny will get a decent deal using their strong stock to buy a depressed stock w/ good potential when it gets Tier 2. Sny either pays $7B now or 5X later. Sny BoD knew that when they approved the partnership.

  • lakers_w lakers_w Jul 21, 2015 8:56 PM Flag

    130M Sny was approved las ASH. 130M * $53/Sny / 409 M Mnkd OS= $17/sh. Sny ran up from $48 to over $53. They will use Sny share as inflated currency to acquire Afrezza biz.

  • He/she will lead the business development team of approximately 30 people and orchestrate the day-to-day business development operations and transaction management. This role, more than any other, lies at the intersection of all corporate functions to establish relations with both science and commercial leaders. This role will require intrinsic capabilities including vision, strategy and partnering driving product and client acquisition, expansion and enhancement of current relationships to drive rapid growth, and expansion of technology and products.

  • Rew12.ultiproDOTcom/MAN1011/JobBoard/JobDetails.aspx?__ID=*78248C4EAD138583

  • Nick Jonas: We must eradicate diabetes stigma

    9th Jul 15 | Entertainment News
    Nick Jonas has opened up about his ongoing battle with Type 1 diabetes.

    Nick Jonas' life "changed dramatically" when he was diagnosed with diabetes.
    The Jealous singer discovered he had the Type 1 form of the condition when he was just 13 years old. Nearly a decade later, the star is joining a new non-profit organisation working to educate people on the autoimmune disease.

    "Nearly ten years ago my life changed dramatically when I was diagnosed with Type 1 diabetes," he said in a statement posted on Beyond Type 1's Instagram page. "Since then, I learned how to manage and live well with this disease and made it my mission to speak openly about it with the hope of helping others deal with the struggles of managing diabetes in their own life.(sic)"

    Beyond Type 1 hopes to create a community for suffers of both Type 1 and Type 2 diabetes to share their stories and get advice. Nick knows from past experience that talking about the condition can raise ignorant questions from people who have not been educated about how it occurs and understands the need for better resources to be provided.

    "When I share my personal story, the questions I most often hear are, "What did you eat that gave you diabetes?" or "Does that mean you were lazy as a kid?" Although it's been difficult to deal with the misinformation out there, I always found a way to not let the lack of knowledge surrounding diabetes affect me," he continued. "I can't do that any longer. Sometimes, something happens in your life and you wonder what good can come of it - these stories will surprise some people and they are meant to. We need to eradicate the stigma that comes from having a chronic illness."

  • Nick Jonas' Diabetes Has Had an Effect on His Songwriting

    Nick Jonas' Diabetes Has Had an Effect on His Songwriting
    Nick Jonas stops to pose with some fans as he leaves Cecconi’s after grabbing lunch with friends on Monday afternoon (July 13) in West Hollywood, Calif.

    The 22-year-old singer recently opened up about a song he wrote about having Type 1 diabetes.

    “‘A Little Bit Longer’ was a song I was really happy to write,” Nick told EW. “Probably in a lot of ways, it’s been therapeutic for me.”

    He added, “It’s really shaped who I am as a person. It has an effect on my creative life, the way I approach writing songs and doing all that..

  • NEW YORK and LOS ANGELES, July 8, 2015 /PRNewswire/ -- EDUCATE. ADVOCATE. CURE. BEYOND TYPE 1 is a non-profit organization dedicated to changing the conversation around diabetes and bringing a new level of respect, understanding and support to the global Type 1 community. Co-Founders Juliet De Baubigny, Nick Jonas, Sarah Lucas and Sam Talbot all have a very personal connection to Type 1 and are excited to come together to share their stories and build the community needed to combat an isolating and confusing disease. BEYOND TYPE 1 is here to be provocative, inclusive and disruptive. By including the real-life faces of those living with the disease, we can change the narrative and help eradicate the stigma that comes from living with a chronic illness.

    Nick Jonas, himself a Type 1 Diabetic diagnosed in 2005 explains his point of view and motivation to join BEYOND in the attached statement.

    BEYOND TYPE 1 CEO Sarah Lucas further adds: "We are providing the lifestyle guide for living beyond the diagnosis in full blown gorgeous color, with voices gathered from around the globe. While we will support programs and efforts that are concentrating on the future and a cure, we are focused on the every day, the now, because Type 1 is 24/7 and people need the tools and inspiration to live beyond, today."

    The founders recognize that there is a different narrative to be told, and a new way to tell it; a strong empowered community can live a dynamic life beyond the diagnosis. With plans for high profile collaborations, curated special events, and through technology and social media, BEYOND TYPE 1 will provide education and awareness, affording a greater capacity for strategic fundraising and ultimately looking forward to a future free of diabetes.

    BEYOND TYPE 1 soft launched in February with an Instagram campaign called "Living Beyond", showcasing the age, range and lifestyle of those living their best life with T1D, not focusing on the disease itself but the brilliance of those affected by it and how they manage it. #thedropspotted was also born on social media from a simple hat with the BEYOND drop logo. These campaigns have already garnered support from high profile individuals both in and around the diabetic community including Shepard Fairey, David Blaine, Stacey Bendet, Brian Boitano, Claudine DeNiro and Genevieve Gorder. To purchase a hat and support #thedropspotted, or to share your story please visit: www.BeyondType1.org

    ABOUT THE FOUNDERS:

    JULIET DE BAUBIGNY- Juliet's son Nicolas was diagnosed with Type 1 in 2012 at the age of five. Juliet joined Kleiner Perkins Caufield & Byers in 2001, and as a partner works with the firm's portfolio companies on areas of human capital. She has served on numerous national and international non-profit boards and campaigns, most notably Product (RED).

    NICK JONAS – Nick Jonas was diagnosed with Type 1 diabetes at the age of thirteen. The multi-platinum selling recording artist, talented actor and philanthropist, continues to support charitable causes that are close to his heart while encouraging youth to follow their dreams in spite of their struggles. He has served as an advocate for a variety of important issues, including health and education for our youth, human rights and most notably, diabetes.

    SARAH LUCAS - Sarah's daughter Mary was diagnosed with Type 1 in 1998 at the age of seven. An event designer, writer and lifestyle expert with a passion for philanthropy, she has raised over $10 million for Type 1 charities over the past 15 years. She has served on the Bay Area Executive Board for JDRF and UCSF Diabetes Center Leadership Council and will serve as CEO of BEYOND TYPE 1.

    SAM TALBOT- Sam was diagnosed with Type 1 at the aged of 12. A star in the culinary world, he has turned his love for food into an innovative career, opening several restaurants and participating in season 2 of Top Chef, where he was named "Fan Favorite." He serves as a role model to adults and children alike by applying his "all-natural" style of cooking to every recipe.

    ABOUT BEYOND TYPE 1: Founded in 2015 by Juliet de Baubigny, Nick Jonas, Sarah Lucas and Sam Talbot, Beyond Type 1 seeks to bring a new level of respect and understanding to those living with Type 1 Diabetes. The founders have personal connection to the disease and they aim to leverage their networks to benefit the Type 1 community. BEYOND TYPE 1 highlights the brilliance of those fighting this disease, and champions patient's rights while always working toward ensuring a cure is on its way. 100% of every dollar raised directly supports the most promising global efforts and programs working to educate, advocate and cure Type 1 Diabetes

    ABOUT Type 1 Diabetes: Type 1 is an autoimmune and chronic condition that occurs when the body's own immune system destroys the insulin-producing cells of the pancreas. Because the pancreas produces little to no insulin, a hormone needed to convert sugar (glucose) to energy, people with Type 1 must inject or pump insulin into their body every day in order to live. Type 1 is currently neither preventable nor curable and the cause is unknown.

    Nick Jonas:

    "Nearly ten years ago my life changed dramatically when I was diagnosed with Type 1 diabetes. Since then, I learned how to manage and live well with this disease and made it my mission to speak openly about it with the hope of helping others deal with the struggles of managing diabetes in their own life.

    When I share my personal story, the questions I most often hear are, 'What did you eat that gave you diabetes?' or 'Does that mean you were lazy as a kid?' Although it's been difficult to deal with the misinformation out there, I always found a way to not let the lack of knowledge surrounding diabetes affect me.

    I can't do that any longer, and that is why I'm excited to join Juliet, Sarah and Sam in BEYOND TYPE 1.

    With BEYOND TYPE 1, we will create a community for diabetics where they can share real-life stories about how they are living beyond Type 1 diabetes, and how they have shown that living with the disease has not slowed them down. Sometimes, something happens in your life and you wonder what good can come of it – these stories will surprise some people and they are meant to. We need to eradicate the stigma that comes from having a chronic illness.

    We have a long way to go in the education of both Type 1 and Type 2 diabetes, and in that lack of knowledge is the even harsher reality that we are still very far from a cure. BEYOND TYPE 1 will also focus on raising funds for research to find a cure. I am confident we will get there someday, but it will take a lot of people doing what they can to help.

    We are strong together."

  • Inhaled Insulin AFREZZA & TOUJEO New glargine Insulin Clinical Overview - 7/22/2015
    iamaillDOTorg/EventCalendar/EventDetails.aspx?ItemID=86&mid=11&pageid=5

  • Inhaled insulin may eventually mean no more shots for some diabetics

    Rebecca Killion gives herself several insulin shots a day, a regimen she has followed for 16 years, to help control her blood sugar. It’s been tough, and still her glucose fluctuates a lot. So she is thinking about beginning a new drug — an inhaled insulin that would mean fewer of the needles she loathes. She hopes it comes with the bonus of better managing her diabetes, reducing risk of damage to her kidneys, eyes and other organs.

    The 57-year-old Bowie, Md., woman heard about Afrezza while it was in clinical trials. Intrigued, she became the patient representative on the Food and Drug Administration panel that provided the feedback leading to the drug’s approval and then its commercial release in February.

    Killion and other panel members reviewed reports from the drug’s manufacturer, MannKind, studied clinical trials and read through the FDA’s own reports. They determined, she said, that Afrezza had potential as an effective way to control glucose with fewer injections.

    Some diabetes doctors are cautiously optimistic that this type of insulin could make life easier for patients who are averse to needles and possibly yield better outcomes. Diabetics inhale a dose before each meal to avoid glucose spikes after eating.

    People with Type 1 diabetes — the less prevalent form, in which the body does not produce insulin — still need a daily injection to provide long-lasting insulin.

    Type 2 diabetics — whose bodies don’t make enough insulin or are resistant to it — can use the inhaled version along with pills, though doctors say some may need a daily injection.

    Some clinicians are skeptical. They feel it’s too early to know if the drug has therapeutic benefits. Its long-term safety and efficacy are still under investigation. The package carries an FDA label warning of health risks for people with chronic lung disease. It advises that Afrezza is not recommended for people who smoke or recently stopped smoking or for children.

    Afrezza comes in premeasured cartridges that patients insert into a small device. They close it and inhale on its tip.

    Killion was 38 when she was diagnosed with Type 2 diabetes, and although that wasn’t the best health news, at least her doctor thought her illness could be managed with pills.

    Three years later, she lapsed into a diabetic coma.

    “I woke up after a few days and heard I had Type 1 diabetes and needed injections every day for the rest of my life,” she said.

    She tried an earlier form of inhaled insulin, Exubera, which was taken off the market in 2007 after a year and a half because of inadequate sales. Killion found the device was awkwardly large and not user-friendly.

    “It was like a bong,” said Killion, adding that dosing units were different from liquid insulin, so patients had to figure out conversions, unlike with the new drug.

    About 29 million Americans, more than 8 million of them undiagnosed, have diabetes, according to the Centers for Disease Control and Prevention. Some may have no symptoms for years, says Robert Ratner, chief scientific and medical officer for the American Diabetes Association, based in Alexandria.

    David Proeber/AP Photo
    David Proeber/AP PhotoScientists say it may be possible to stop the auto-immune response in type 1 diabetes patients that causes the destruction of insulin-producing cells.

    Some people inject themselves three or more times a day, sometimes for 50 or 60 years, tempting them to stop the grueling routine, and interrupting treatment can be dangerous.

    “People take an insulin holiday because it’s hard to do that often and long,” Ratner said. “And there are negative social perceptions that deter insulin usage.”

    Many diabetics, he said, are not comfortable taking out a syringe and injecting themselves in public — in the lavatory of a restaurant, for example, before having a meal.

    “We don’t know if Afrezza will do better, but a lot of lessons were learned from Exubera,” Ratner said, “and this is a better product.”

    Killion has gotten her share of suspicious looks when she takes out her insulin vial and needle case in public or at work. “I was in a conference,” she said, recalling one experience, “and a woman yelled from across the table, ‘What are you doing?’ ”

    Studies report that Afrezza reaches peak levels in 12 to 15 minutes, vs. an hour with injected insulin. And the body returns to pre-meal insulin levels quicker.

    “This means Afrezza matches [natural body] dynamics of food intake and absorption well,” said Janet McGill, an investigator on Afrezza trials at the Washington University School of Medicine in St. Louis.

    The most common adverse reactions are cough, throat irritation and hypoglycemia (low blood sugar); people with chronic lung problems may experience wheezing and constriction of air passages in the lungs.

    The FDA is requiring further study to evaluate safety and efficacy in children. And Afrezza will be evaluated for cardiovascular risk and its long-term effect on pulmonary function.

    As a precaution, patients must be monitored for lung function, said Dan Lorber, a New York endocrinologist who was among the investigators involved in the drug studies.

    Farhad Zangeneh, an endocrinologist in Sterling, Va., began his first patient on Afrezza in March. The patient had long-standing, poorly controlled Type 2 diabetes, despite a daily long-acting injection, multiple pills, a good diet and exercise. Even that one shot was hard, as he deeply feared needles. Rather than amp up the injections, Zangeneh prescribed Afrezza.

    “His glucose profile improved immediately and he has not had hypoglycemia,” he said.

    Zangeneh has his patients take classes to learn how to use the inhaler, how the drug works and what the alternatives are.

    “I want to make sure they understand not only how to use Afrezza, but other options. Then, if they have no lung issues and do not smoke, if they prefer inhaled insulin, I have no reservations,” he said.

    Natasa Janicic-Kahric, an endocrinologist at MedStar Georgetown University Hospital in Washington, just began her first patient on Afrezza. The patient was badly bruised from years of insulin injections, and consequently was not absorbing it well. Janicic-Kahric hopes the inhaled drug will be more readily used by her body. She is also discussing this option with several patients who say they’ve grown weary with multiple injections.

    “The inhaled option is convenient,” she said. “But I would prefer to wait a little longer to conclude whether it is effective.”

    Janicic-Kahric is not sure she will offer it to Type 1 patients, uncertain it can provide the precise glucose control they require, since it comes in prepackaged doses. With injections, patients can vary the amount of insulin they receive by tiny amounts.

    “Type 1 diabetics are much more sensitive to insulin, and even one unit too high or low can have a significant impact,” she said. “I’m hoping with time we will have more dosing options. Then I would more readily prescribe for Type 1.”

    Zangeneh said he, too, would rarely prescribe Afrezza for Type 1 diabetics. If they are averse to shots, he prefers that they use a pump, which delivers insulin through a catheter placed under the skin.

    Some endocrinologists are pleased that patients who may benefit from the drug would no longer have to plan their doses of insulin in advance of meals. Nor would they have to refrigerate it.

    “They can sit at a table anywhere, take their inhaled insulin, and begin to eat right away,” Janicic-Kahric said.

    Afrezza’s wholesale cost is about double that of injected insulin. But it should not cost consumers more. The company commercializing it, Sanofi, caps co-pays at $30, said Stefan Schwarz, vice president and head of U.S. marketing for Afrezza at Sanofi.

    Killion is hopeful that Afrezza will help with an ongoing balancing act.

    “After I eat, my glucose can go from 120 to 280 in 45 minutes. When it starts to come down, my insulin kicks in, and sometimes I get sugar lows because I have inadvertently overcorrected. It lingers and affects the next dose. It seems you are always chasing highs,” she said.

    “Based on the literature, this insulin tends to act more like how my body would if I didn’t have this illness.”

    What makes Killion happiest is that insulin-dependent diabetics may have a choice besides sticking something into their bodies.

    “This is for the rest of their lives, and it gets old, taking five, six shots a day. An option other than a needle is huge.”

SNPS
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