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Post by stevil on Jun 3, 2022 12:52:31 GMT -5
I've been skimming through these longer posts so I'm not sure if all of this has been covered already or not. There were a few points I wanted to make that will hopefully fill in some gaps.
In my opinion, I think the peds trial is the way forward for the company for mass adoption. I don't see it coming first from the type 2 community... or anytime soon for that matter, regardless of how well it goes for peds. The reasons are multifactorial and have been discussed nearly ad nauseum. The biggest reason peds has a higher chance of taking Afrezza to the next step is that it's because parents care more about their child's health than an adult with type 2. The early adopters of Afrezza in the type 1/2 community are unique. Not too many adults care about meticulously managing their disease, have the financial means to do so, or are actively seeking the "latest and greatest" in regard to treatment. For the vast majority of patients, "good enough" is enough.
Unfortunately, people without clinical experience have strong opinions on this matter and it confuses many who understand the benefits of Afrezza on paper and wonder why it hasn't been adopted more quickly and on a wider scale. It really is very simple. Other medications are cheaper, more attainable, better covered by insurance, and require fewer interventions for "good enough". We see this every day. People know going for the salad is the better dietary choice. But they reach for the cake instead. People buy processed foods in the grocery store because they're cheaper than healthier foods. It's not an education problem, it's a convenience problem. Some may say it's easy to inhale a dose with every meal, and it is if no thought goes into a dose. I'm sure for the people who have experience with Afrezza and have it dialed in, it's become second nature. Getting there, though, takes up to months of working to understand the medication and how it affects the body. Diabetes is difficult to manage because there are so many different variables that can affect glucose regulation and doses will change depending on those variables. Some people don't want to be bothered with making daily adjustments to their treatment. Some people would rather inject once a medication week instead of picking up an inhaler 3-6 times a day, regardless of how simple of a task that may be.
So, having said all that, the reason I think peds is the gateway to as much of an adoption of Afrezza as we'll see anytime soon is because parents are willing to spend money on their children. They're willing to work harder to make sure their children are getting "the best" treatments available. They'll not content with "good enough" and will make sure their children are trained well to manage their disease. Also, most children will qualify for CGMs so the benefits of Afrezza will be on display to see. Perhaps the biggest reason is the networking ability of a mother. Moms are all over social media all the time. You can guarantee that if one mother has a good experience that it won't be long for 10 more to hear about it. Word of mouth is the strongest influencer and marketing tool. If I were Mannkind, I'd look for ways to support mothers and make sure they have all they need to equip themselves. I remember reading on here many years ago that there was a website MNKD was working on for people to share their stories and to collaborate with other current users. I think this tool would be invaluable and would help greatly to make peds flourish.
Sure, the type 2 market is way bigger than type 1, and even more so just peds. If I had to put my money on anything, I'm betting on a caring mother and her inability to stop from telling 10 of her friends if she's found something valuable.
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Post by Thundersnow on Jun 3, 2022 13:28:20 GMT -5
Can you imagine MNKDs rise today if the NASD was positive?? OMG
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Post by sportsrancho on Jun 3, 2022 14:45:07 GMT -5
Stevil…. I agree, but you could say with Afrezza you can eat cake, although I shouldn’t say that, I’m not supposed to say that, but I just said it🤣
My next-door neighbor T1…is getting put on Afrezza very soon because she’s going to Florida for a month on vacation and she does not wanna wear that pump in the ocean!
I agree with the mothers of the children for sure. They were bitching on Facebook today about how they can’t get eagle pharmacy to give them a script for anybody 18 and under.
There’s already more kids, more parents wanting prescriptions for their children and they’re not waiting for any trial.
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Post by phdedieu12 on Jun 3, 2022 15:02:22 GMT -5
2 facts we should all agree on. 1. Until we do a study that shows afrezza is superior, and not merely non-inferior, it will never move up in the SOC. You can spend all day writing about how great afrezza is but it is a waste of time without the clinical study to back it up. 2. #1 takes money. If mnkd doesn't want to spend the money, they should sell adrezza to a company that will. It is posts like these and conclusions like those that make me wonder. Why don't you just sell your position and go ramble somewhere else. I thought this would be a great place to get some information, but this s little more than water cooler, Monday morning quarterbacking forum. All I hear and read is: Blah blah blah blah blah. MC is terrible, company can't do anything right, management sucks, as if you're anywhere qualified to be a CEO yourself. What a waste of time..... |
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Post by stevil on Jun 3, 2022 15:21:00 GMT -5
Stevil…. I agree, but you could say with Afrezza you can eat cake, although I shouldn’t say that, I’m not supposed to say that, but I just said it🤣 My next-door neighbor T1…is getting put on Afrezza very soon because she’s going to Florida for a month on vacation and she does not wanna wear that pump in the ocean! The problem with the way the current management of diabetes is structured, you can eat cake with a GLP-1 and still have a modest A1c. You'll still have the spike, but it won't be as high or last as long as with previous non-insulin treatments. The hard sell for Afrezza is going to come from improved long-term outcomes with better post-prandial control than GLP-1s that comes from improved TIR. Until a compelling case is made to show why treatment should be focused on controlling PPG and better TIR, I fear Afrezza will always be reached for last in the treatment algorithm for most prescribers. Just for the record, I don't always follow guidelines or think they should be used to direct all decisions. If all we were supposed to do was follow algorithms, medical school was an enormous waste of resources and time. I refuse to practice that way. Every patient has their own needs that need to be considered when deciding treatment. |
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Post by agedhippie on Jun 3, 2022 15:31:54 GMT -5
2 facts we should all agree on. 1. Until we do a study that shows afrezza is superior, and not merely non-inferior, it will never move up in the SOC. You can spend all day writing about how great afrezza is but it is a waste of time without the clinical study to back it up. 2. #1 takes money. If mnkd doesn't want to spend the money, they should sell adrezza to a company that will. Lets all first agree that Affinty2 found afrezza superior and not non-inferior. However, Mounjaro is the new big whale and a targeted trial will show afrezza superior. If Mike has money to buy V-Go then he has money to do a trial against Mounjaro. However, MNKD IMO should partner on the trial. Let's rather say that in a group of Type 2 diabetics inadequately controlled on oral meds adding Afrezza improves is superior to doing nothing. That's a particularly low bar and why Affinity 2 never got traction. A better comparison would have been to move 1/3 to Afrezza, 1/3 to the next step in the SoC, and 1/3 do nothing. Now you are showing Afrezza outperforming the SoC rather than outperforming doing nothing and that would get traction. The 175 trial played it safe and blew that chance. |
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Post by akemp3000 on Jun 3, 2022 16:14:11 GMT -5
One thing really good about this MNKD message board. While there are plenty of disagreements and interesting perspectives that are shared, it rarely digresses to personal attacks. The moderators here do an outstanding job of allowing free speech...to a point. Just saying  |
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Post by sweedee79 on Jun 4, 2022 0:22:48 GMT -5
2 facts we should all agree on. 1. Until we do a study that shows afrezza is superior, and not merely non-inferior, it will never move up in the SOC. You can spend all day writing about how great afrezza is but it is a waste of time without the clinical study to back it up. 2. #1 takes money. If mnkd doesn't want to spend the money, they should sell adrezza to a company that will. It is posts like these and conclusions like those that make me wonder. Why don't you just sell your position and go ramble somewhere else. I thought this would be a great place to get some information, but this s little more than water cooler, Monday morning quarterbacking forum. All I hear and read is: Blah blah blah blah blah. MC is terrible, company can't do anything right, management sucks, as if you're anywhere qualified to be a CEO yourself. What a waste of time..... He has a right to his opinion regardless of how unsettling it is to you!!!! Uvula says it like he sees it.... He is genuine!!! We need everyone's genuine and sincere opinions here!!! Keeps us grounded and allows us to consider other points of view... |
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Post by sayhey24 on Jun 4, 2022 6:41:41 GMT -5
Lets all first agree that Affinty2 found afrezza superior and not non-inferior. However, Mounjaro is the new big whale and a targeted trial will show afrezza superior. If Mike has money to buy V-Go then he has money to do a trial against Mounjaro. However, MNKD IMO should partner on the trial. Let's rather say that in a group of Type 2 diabetics inadequately controlled on oral meds adding Afrezza improves is superior to doing nothing. That's a particularly low bar and why Affinity 2 never got traction. A better comparison would have been to move 1/3 to Afrezza, 1/3 to the next step in the SoC, and 1/3 do nothing. Now you are showing Afrezza outperforming the SoC rather than outperforming doing nothing and that would get traction. The 175 trial played it safe and blew that chance. To keep things short I'd rather say what the press release said. Raising the bar is easy too. A follow-on trial with proper dosing targeted at Mounjaro. What we know from Affinity2 is they under dosed but still got superior results. Highlights AFREZZA combined with oral therapy, compared to oral therapy alone, showed: Superior reductions in A1c levels; Significantly more patients reached A1c target levels; Reduced postprandial glucose excursions; and No significant difference in the incidence of severe hypoglycemia. investors.mannkindcorp.com/news-releases/news-release-details/mannkind-reports-positive-data-phase-3-clinical-study-afrezza-0 |
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Post by phdedieu12 on Jun 4, 2022 7:04:01 GMT -5
It is posts like these and conclusions like those that make me wonder. Why don't you just sell your position and go ramble somewhere else. I thought this would be a great place to get some information, but this s little more than water cooler, Monday morning quarterbacking forum. All I hear and read is: Blah blah blah blah blah. MC is terrible, company can't do anything right, management sucks, as if you're anywhere qualified to be a CEO yourself. What a waste of time..... He has a right to his opinion regardless of how unsettling it is to you!!!! Uvula says it like he sees it.... He is genuine!!! We need everyone's genuine and sincere opinions here!!! Keeps us grounded and allows us to consider other points of view... Of course he does, it's a free country. His comment isn't unsettling at all, you seem to be missing the point as well. I joined this board seeking insight, and information not random off the cuff comment like that one. My retorque: if you seem so annoyed and disappointed by the decisions made or the direction of the company, sell your shares to someone who isn't. But this confirms that this is just a place for armchairs CEO to vent. Which to me serve little to no purpose. |
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Post by sayhey24 on Jun 4, 2022 7:13:02 GMT -5
Stevil…. I agree, but you could say with Afrezza you can eat cake, although I shouldn’t say that, I’m not supposed to say that, but I just said it🤣 My next-door neighbor T1…is getting put on Afrezza very soon because she’s going to Florida for a month on vacation and she does not wanna wear that pump in the ocean! The problem with the way the current management of diabetes is structured, you can eat cake with a GLP-1 and still have a modest A1c. You'll still have the spike, but it won't be as high or last as long as with previous non-insulin treatments. The hard sell for Afrezza is going to come from improved long-term outcomes with better post-prandial control than GLP-1s that comes from improved TIR. Until a compelling case is made to show why treatment should be focused on controlling PPG and better TIR, I fear Afrezza will always be reached for last in the treatment algorithm for most prescribers. Just for the record, I don't always follow guidelines or think they should be used to direct all decisions. If all we were supposed to do was follow algorithms, medical school was an enormous waste of resources and time. I refuse to practice that way. Every patient has their own needs that need to be considered when deciding treatment. Stevil - if you stop the spike and get the T2 back to baseline, the T2 if producing enough fasting insulin will maintain near normal levels. GLP1s just don't stop the spike. Nor do they help with insulin replacement to lower the BG. This is why DeFronzo always combines his GLP1 trials with glimepiride. I call it spiking the punch and then we give all the credit to the GLP1. The hard sell for afrezza is not long term outcomes. We know what insulin does and how it acts. Insulin is not some new fangled thing. What is new with afrezza is delivering it as a monomer. If prescribed early in most cases you will see progression stopped and in some cases see some reversal. We also know that a BG over 140 for 2+ hours causes vascular degeneration. The easy sell is getting the PWD to prefer afrezza over the GLP1 and SGLT2 with all the side effects they have. Just read the GLP1 and SGLT2 labels if you want a little scare. The hard sell is getting the ADA to put it as step 2 in their SoC. Its about BIG $$$. It is not about doing the right thing for the PWD. That simple change according to Dave Kendall and I second would get doctors to prescribe. The problem was Dave found out the hard way this was not going to be easy. Also, afrezza does not need to show better post-prandial control than GLP-1s that comes from improved TIR. What Mike needs to do is show better A1C against Mounjaro. That is the current standard, A1C not TIR. Right or wrong thats all the ADA wants to hear about when they are trying to block something. The great news is properly dosed afrezza will kick Mounjaro's butt in A1C. We just need the formal and highly publicized trial with headlines at ADA 2023. Even then Mike will probably need to sue to get afrezza in its proper place in the ADA's SoC. At this point Mike needs to start playing hardball. Hopefully he is all set for a BIG Show at 4:30pm today at the theater with some "Seeing is Believing". |
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Post by agedhippie on Jun 4, 2022 8:44:35 GMT -5
To keep things short I'd rather say what the press release said. Raising the bar is easy too. A follow-on trial with proper dosing targeted at Mounjaro. What we know from Affinity2 is they under dosed but still got superior results. ... That trial was always going to deliver superior results for Afrezza - both group continued on their oral meds, and one group added Afrezza. If you add an extra drug it's going to outperform the do nothing arm (well, not always. Some drugs have failed spectacularly over the years!) You could equally have improved their A1c by adding GLP-1 or basal insulin. That's why Affinity 2 failed to get traction. Naturally the PR didn't raise that and was tightly scoped, but it looks like the doctors did.  I entirely agree about a trial between Afrezza and Mountjaro, and it needs to be done ASAP. Lilly will support Mountjaro with lots of follow on trials and studies to build a deep bench of trial data. The longer Mannkind waits to challenge it the bigger the task will be. |
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Post by cretin11 on Jun 4, 2022 9:12:59 GMT -5
He has a right to his opinion regardless of how unsettling it is to you!!!! Uvula says it like he sees it.... He is genuine!!! We need everyone's genuine and sincere opinions here!!! Keeps us grounded and allows us to consider other points of view... Of course he does, it's a free country. His comment isn't unsettling at all, you seem to be missing the point as well. I joined this board seeking insight, and information not random off the cuff comment like that one. My retorque: if you seem so annoyed and disappointed by the decisions made or the direction of the company, sell your shares to someone who isn't. But this confirms that this is just a place for armchairs CEO to vent. Which to me serve little to no purpose. Sweedee isn’t missing the point. And a retort to you is that your posts here don’t seem to be adding much either. But it’s a message board, people can post what they want as long as it’s respectful, and nobody has to read it if they don’t want to. |
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Post by dh4mizzou on Jun 4, 2022 9:34:37 GMT -5
He has a right to his opinion regardless of how unsettling it is to you!!!! Uvula says it like he sees it.... He is genuine!!! We need everyone's genuine and sincere opinions here!!! Keeps us grounded and allows us to consider other points of view... Of course he does, it's a free country. His comment isn't unsettling at all, you seem to be missing the point as well. I joined this board seeking insight, and information not random off the cuff comment like that one. My retorque: if you seem so annoyed and disappointed by the decisions made or the direction of the company, sell your shares to someone who isn't. But this confirms that this is just a place for armchairs CEO to vent. Which to me serve little to no purpose. phdedieu12, I think you're expecting too much from this site. IMO what you're asking for will cost you more than we all pay here (which for me is $ 0.00). You'll be better served by signing up for one of the myriad stock picker sites (like Nate's, etc.) We're mostly individual investors from a huge variety of backgrounds that wish to share our thoughts on MNDK and other stocks. I'd suggest you reset your expectations for this board or look for a site that will deliver what you're looking for. Not trying to be an arse but simply trying to help you realize what this site provides. If you should decide to move on I wish you nothing but the best. If you decide to stick around I look forward to your thoughts and perspective. |
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Post by phdedieu12 on Jun 4, 2022 15:28:48 GMT -5
Could not agree with you more, and didn't think of your comment as being an arse at all. I have found many posts interesting, informative and in many cases made me think about things differently. I enjoy getting the weekly scripts, etc... Every once in a while, like on Uvula's post I simply scratch my head and wonder what the point is, beside venting. And I find NO value whatsoever in that type of commentary, whether it'd be genuine and sincere or not. I am not looking for stock picking advice, but clearly need to look at this board in a different light as you stated.
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