Lack of efficacy, a lack of a partner and a similar product that has been linked to lung cancer - those are the three main reasons why MannKind’s inhalable insulin product, Afrezza, is not likely to have a great impact on the market for diabetes treatments, according to Sydbank analyst, Søren Løntoft Hansen.

Last week, MannKind presented data from two phase III studies with the medicine, but even though the share went up significantly, and even though the company proclaimed the data to be very strong, Søren Løntoft Hansen is not impressed.

“It’s not data that knocks my socks off, I have to admit. They do deliver a decrease in long-term blood sugar, but it is only half of what Novolog/NovoRapid manages. The smaller drop might also explain the fewer incidences of low blood sugar from Afrezza. You also lose a lot of the effect by taking your insulin through the lungs rater than by injection. It’s not impressive, and it’s not something that sways me,” he tells Medwatch.

None of the majors

Pfizer’s inhalable insulin, Exubera, was pulled from the market in 2007 after a year, partly due to disappointing sales figures and partly due to a study that showed an increased risk of developing lung cancer.

“At that time, all the three majors, Novo Nordisk, Eli Lilly, and Sanofi, were developing inhalable insulins, and they all gave it up with the very simple reason that it would never result in anything. I think a great many diabetes doctors have the risk of lung cancer in the back of their minds.”

Moreover, MannKind does not have a partner and, keeping past experiences in mind, the analyst does not believe Eli Lilly, Novo Nordisk or Sanofi would be interested in partnering with MannKind. That will also offer greater challenges for the company in terms of distribution and marketing.

“They might be able to market a drug, but at the end of the day it’s about efficacy, and I don’t belive the efficacy of Afrezza is good compared with injectable insulins.”

No paradigm shift

Novo Nordisk’s CSO, Mads Krogsgaard Thomsen, has previously explained to Medwatch that the company has conducted surveys showing patients using Pfizer’s product found it to be more inconvenient than injecting the insulin twice a day. However, the analyst does not think convenience is a barrier anymore.

“That barrier belongs to the past, because the inhaler that came with Pfizer’s product was a very large and unhandy apparatus that had to be disassembled and washed after use. But my impression is that the inhaler MannKind uses is far more convenient and easy to use,” he says, but points out:

“If you think this will result in a paradigm shift in the use of fast-acting insulins, you are setting yourself up for a disappointment.”

- translated by Martin Havtorn Petersen

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