MannKind leadership promises Afrezza will survive

New CEO Matt Pfeffer spoke at a JP Morgan investor conference last night and pledged that Afrezza is “here to stay. I don’t want anybody, especially our patients out there, to have any questions about that. This is a product that has done tremendous things for an awful lot of people, and we will make this work.”

The company is exploring many possibilities for its transition away from Sanofi, and though Pfeffer has only held the CEO post for a few days (he’s also the CFO), he says the company’s leadership is energized and determined. One thing he mentioned in particular is that Sanofi priced Afrezza too high and success will depend on pricing that attracts patients and insurers. He also said Afrezza is a unique therapy that requires special training and education for physicians and their patients and the company will be working on that.

He said cash burn is improving and current cash on hand will get the company through the middle of the year, while there is further cash “we have line of sight to.”

The company certainly has a long way to go and hopefully has the right leadership to get it there.


Happy to hear this news!

Although my 13 year-old daughter does not use Afrezza, and I’m hoping that a version of the AP will be available some time before Afrezza is approved for children, I see how incredibly effective Afrezza is for those currently using it. The thought of you guys not being able to continue using Afrezza had me seriously bummed.


No guarantees, of course, but at least they are optimistic.

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Thanks for your concern. Afrezza is only a bolus insulin and fantastic for correcting highs, so Type 1s always need the pump or a basal insulin. I think a pump with Novolog in it and Afrezza for meals and highs would be ideal. My daughter has never had less than 3 and often 5 basal rates when on the pump so Lantus and now Tresiba still does not give her the extra basal she needs from 6pm to 1am. Otherwise, Tresiba does suffice. Hopefully children will have access to Afrezza in smaller doses. It’s great for corrections because it is so fast. It also makes it easier to figure out basal rates because it is out of the system so quickly. And children, even in the UK and Canada have difficulty getting approved for pumps; most of those kids are on shots which is a nightmare during childhood with all the growth spurts and crazy changes in the basals. I hope Afrezza can survive and if not we’ll just have to wait for SmartInsulin but that will be at least five years, most likely ten.

I’ve been snooping on the Mannkind message board and I am so grateful to the longs; those shareholders are going to hold on to the bitter end; they definitely know the value of the drug and how it works. They are a loyal and feisty bunch. There was a Powerpoint presentation (only saw one page) in which they are planning to have Afrezza included in urgent care centers one in New Jersey; hopefully some in Manhattan, Westchester and Long Island. Diabetics will be offered a script if they choose to use Afrezza, it WILL BE AN OPTION! And they will train in titrating the drug, something that escapes us sometimes since DD won’t wear Dexcom. Afrezza users should post meals and how they used Afrezza for different types of meals, to give an idea. Everyone is an individual but I think this would be very helpful. We gave found Sam’s tip of using Afrezza a half hour after a pasta dish (we bolus half for pasta) upfront, half later. For us the correction comes at the 2 or 3 hour mark; she’s low till then. The most important part is just getting a prescription for it here in the New York City area. Then you need an endo who will help you appeal so your insurance will cover it. Alas, I have found that adult endos may be less inclined to take the time than our pedi endos. But the endos at these centers must put in the time to help fight the insurance for coverage. Few people can shell out $1,000 month. We are paying $500 with the card. Even if one could not afford full time use of Afrezza they could use it for the first part of the meal (first phase insulin response) and all highs of course. Everyone who knows how it works will want it even if they use other bolus insulin in conjunction. They used Afrezza with the pump in an AP trial in Spain. There pts had no spike whatsover and the pump took care of the rest of the meals. So level blood sugars with Afrezza and pump.

Julia, you will find some tips from Afrezza users in the following posts:

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Thanks, Charles. We basically have to figure the dosing for pasta and Afrezza. Per one of Sam’s posts we take half the dose one half hour after eating pasta. If on Apidra, we would give the other half of the bolus two hours after eating. The Apidra takes 3 hours so it would work. Sometimes she will spike two hours after sometimes three. But it is a slow rise. Afrezza very fast. We have to wait until she is about 200 to give the second Afrezza dose. With most foods, she uses full dose of Afrezza right after eating, tests blood sugar in an hour to an hour and a half and will need more Afrezza. Almost always two doses, not one. But it’s so easy for her; dosing is no big deal. She has no cough, no side effects whatsoever. The cgms and Afrezza go hand in hand and you can achieve perfection or close to it. For those teens refusing to wear Dex, it’s still better than anything she has had but she can’t see the exact moment her blood sugar starts to rise, how fast it’s rising, etc. It’s great for corrections. She uses a lot of 4 unit doses in evenings for correction as that is the time of night she needs the most basal. After eight years on the pump, she was tired of that too. Even with Tresiba, that’s one flat dose, so that insulin does last. But most Type 1s have a few different basal rates throughout the day, not one flat dose. So those extra boxes of 4 units are going to be key.

When I first started using it, I posted a play by play including quite a few different types of meals and how I approached them, things that worked and things that didn’t, lessons learned, etc. the thread has been inactive for months now but you can find it by searching for “taking the plunge with afrezza” on this forum. I hope it’s helpful.

Yes, very. We mainly have problems with pasta. Plus she was having some unexplained (for Afrezza) highs recently. I queried her and she mentioned she looked, found extra powder in inhaler after use, so is inhaling more deeply and works better. She was not taught to exhale before use and keeps forgetting to do that. Is exhalation necessary before the first inhalation?

Well to inhale deeply I think it helps to exhale deeply first…

Standing or sitting up straight and facing strait ahead helps to insure the airway is open wide too… And of course like I always say with this stuff, timing is everything, dosing almost doesn’t matter…

Refuses to wear Dex or pump. Does not want to feel like “robot” was on pump from 8 to 16 years. We dose immediately after eating. She checks sugar one hour after eating. But I think it was her technique. She would sometimes sit down slumped back. I have seen her correct in bed lying down. So doc who prescribed it did not go into the exhalation part which I brought up with her. Pasta we dose half the carb amount a half hour after eating and correct two or three hours after, which is when her blood sugar has always started to rise for pasta. I really think some of the unexplained highs we have been seeing was technique related. Or basal related since she is not on pump. Tresiba is flat; her basals are not. I have read your and other blogs in the past. Will reread the old threads. For newbies, need to be an Afrezza related blog detailing how users dosed for food up and running. Although everyone is different. My DD loves Afrezza but wants to enjoy life without thinking about diabetes all the time. Does not want to blog on subject. I am not using Afrezza myself, and she is away at college, not really able to document and should not do so as I don’t use it. And I only document her Afrezza use and blood sugars when she is on break. The reason we need all this information out on dosing is they are going to set up centers to dispense Afrezza and the new users should be sent to one place to get the tips and tricks so to speak. It should not be here on Tu D if the thread is archived. Needs to be up and running with user participation and documentation. I would hate for people to try Afrezza and discontinue because they dosed too soon for certain foods or didn’t correct soon enough. For us, even if she is high, she can come down in one hour, not 3.5 so we would never voluntarily give it up. P.S. I am talking mostly for those who do not or will not use cgms; none of her diabetic friends use it. But they can still get the timing right for most meals.