Experience with endo

[xoxoxoxo]

So I recently went with my parent who has been a type 2 for about 20 years on insulin for about the past 7 years..    I don't go very often to appointments since I live in a different state.  The only reason I've been involved with Afrezza is because of my parent's issues over the years and being exposed to everything diabetes since I don't have diabetes.

Anyways, this endo is at the cleveland clinic's diabetes center and has been really good and I still think highly of them.  Towards the end of the appointment I asked if they had anyone on Afrezza and they said they just had a scientific presentation on it last week.

However, they haven't prescribed afrezza yet and I basically got a lecture about how they're concerned about the dosing especially the variable dosing between patients.   They then explained that there are a lot of people who aren't candidates because of the lung function testing that's required.  So basically I was pretty disappointed, I really don't think they understand why 8u Afrezza is indicated when the scale says the patient should only have 5-7u.  I'm sure this diabetes centers sees hundreds of patients each week.  

My parent is extremely insulin resistant taking about 60u of levemir each day and 15-20u of novolog on a sliding scale at meals, so I've been waiting until the 12u dosage came out and to get some info from early adopters before I start trying to convince my parent that Afrezza is a good idea.  My parent has relatively poor control because of not testing very often and sometimes forgetting to take insulin.  That's a whole separate challenge which is why I think Afrezza would be a better idea because it's so much easier to take and might improve compliance.

After this I'm convinced our lower than expected script counts is due from doctors being unfamiliar or not hearing about the results/patient success stories.  I wasn't going to argue with the endo about Afrezza, so I just listened and said thank you.  I plan to put some stuff together later this year for my parent to take in after the 12u dosage is available depending on whether he improves.

[compound26]

Jul 17, 2015 16:30:27 GMT -5 xoxoxoxo said:

So I recently went with my parent who has been a type 2 for about 20 years on insulin for about the past 7 years..    I don't go very often to appointments since I live in a different state.  The only reason I've been involved with Afrezza is because of my parent's issues over the years and being exposed to everything diabetes since I don't have diabetes.

Anyways, this endo is at the cleveland clinic's diabetes center and has been really good and I still think highly of them.  Towards the end of the appointment I asked if they had anyone on Afrezza and they said they just had a scientific presentation on it last week.

However, they haven't prescribed afrezza yet and I basically got a lecture about how they're concerned about the dosing especially the variable dosing between patients.   They then explained that there are a lot of people who aren't candidates because of the lung function testing that's required.  So basically I was pretty disappointed, I really don't think they understand why 8u Afrezza is indicated when the scale says the patient should only have 5-7u.  I'm sure this diabetes centers sees hundreds of patients each week.  

My parent is extremely insulin resistant taking about 60u of levemir each day and 15-20u of novolog on a sliding scale at meals, so I've been waiting until the 12u dosage came out and to get some info from early adopters before I start trying to convince my parent that Afrezza is a good idea.  My parent has relatively poor control because of not testing very often and sometimes forgetting to take insulin.  That's a whole separate challenge which is why I think Afrezza would be a better idea because it's so much easier to take and might improve compliance.

After this I'm convinced our lower than expected script counts is due from doctors being unfamiliar or not hearing about the results/patient success stories.  I wasn't going to argue with the endo about Afrezza, so I just listened and said thank you.  I plan to put some stuff together later this year for my parent to take in after the 12u dosage is available depending on whether he improves.

I agree, the hurdles for Afrezza is really the physicians (their lack of understanding of Afrezza). Once the physicians embrace Afrezza (on a wide scope), patients will naturally abandon the RAA injections.  Of course, it appears currently, most of the patients haven't heard of Afrezza either.  Education to both physicians and patients are needed.  Better understanding by either group (physicians or patients) will help drive increase of scripts.

[babaoriley]

Thanks for posting your experience, xoxoxoxo. I'm trusting that the Sanofi reps are sufficiently versed to relay the story and capabilities of Afrezza in the best way possible to physicians.

[newmnkdinvestor]

Good post. I was debating about sharing my experience today. MNKD longs can be so sensitive. Anyway

I went to Mt Sinai in NYC today for my endo appointment with a new Dr. FYI I am not diabetic. However it was my opportunity to talk about Afrezza. No one at that hospital was prescribing it and they were not planning to either. He was totally misinformed and brought up pulmonary issues. He did look at the Twitter results and was really impressed.


SNY has their work cut out for them.

I am totally bearish on commercials or DTC being a success. This is going to come down to Dr's. The people who demand it will be turned away by a misinformed Dr. The ones that find a new Dr are not enough to make the cost worth the conversion.

[babaoriley]

These issues are being addressed, but it can only go slowly. These doctor - doctor get togethers (where the docs who are friends of Sanofi get together with other docs in their area) should help a lot, but, again, it will take time.

[mrhaigs]

Jul 17, 2015 17:52:21 GMT -5 babaoriley said:

These issues are being addressed, but it can only go slowly. These doctor - doctor get togethers (where the docs who are friends of Sanofi get together with other docs in their area) should help a lot, but, again, it will take time.

It's been 5 months. Slowly is an understatement. It didn't take long for toujeo to start selling. The numbers are incomparable.

[mannmade]

Toujeo does not represent a paradigm shift of seismic proportion as Afrezza does. Toujeo is merely a brand extension of an already existing product (Lantus) and thus has a built in user friendly base of many millions. Afrezza is starting from scratch and requires education on many misunderstood issues such as carb counting.

[newmnkdinvestor]

Jul 17, 2015 18:05:56 GMT -5 mannmade said:

Toujeo does not represent a paradigm shift of seismic proportion as Afrezza does. Toujeo is merely a brand extension of an already existing product (Lantus) and thus has a built in user friendly base of many millions. Afrezza is starting from scratch and requires education on many misunderstood issues such as carb counting.

I agree comparing the two make no sense.



The reason I share my information with the board is because a lot of MNKD longs are expecting big things and soon. That's not happening. I am just trying to temper expectations.

[notamnkdmillionaire]

Jul 17, 2015 16:30:27 GMT -5 xoxoxoxo said:

So I recently went with my parent who has been a type 2 for about 20 years on insulin for about the past 7 years..    I don't go very often to appointments since I live in a different state.  The only reason I've been involved with Afrezza is because of my parent's issues over the years and being exposed to everything diabetes since I don't have diabetes.

Anyways, this endo is at the cleveland clinic's diabetes center and has been really good and I still think highly of them.  Towards the end of the appointment I asked if they had anyone on Afrezza and they said they just had a scientific presentation on it last week.

However, they haven't prescribed afrezza yet and I basically got a lecture about how they're concerned about the dosing especially the variable dosing between patients.   They then explained that there are a lot of people who aren't candidates because of the lung function testing that's required.  So basically I was pretty disappointed, I really don't think they understand why 8u Afrezza is indicated when the scale says the patient should only have 5-7u.  I'm sure this diabetes centers sees hundreds of patients each week.  

My parent is extremely insulin resistant taking about 60u of levemir each day and 15-20u of novolog on a sliding scale at meals, so I've been waiting until the 12u dosage came out and to get some info from early adopters before I start trying to convince my parent that Afrezza is a good idea.  My parent has relatively poor control because of not testing very often and sometimes forgetting to take insulin.  That's a whole separate challenge which is why I think Afrezza would be a better idea because it's so much easier to take and might improve compliance.

After this I'm convinced our lower than expected script counts is due from doctors being unfamiliar or not hearing about the results/patient success stories.  I wasn't going to argue with the endo about Afrezza, so I just listened and said thank you.  I plan to put some stuff together later this year for my parent to take in after the 12u dosage is available depending on whether he improves.

thanks for the update and info. It goes to what I have always feared and staeted before that adoption will be slow and that doctors set in their way will be stubborn about trying new things. Even with the scientific presentation, doubt still lingers. Is the presentation not geared to clear up how Afrezza works differently than current insulin? Per your remarks, it appears so because the doc stated they don't yet understand the dosing. One has to scratch their head if this is the case. It also reinforces what I stated a day or two ago that all you need is one or two patients to help break that misconception dam of doctors for the doctors to realize how it works. The doctors will always stick to the notion that if a patient is under control, there is no need to change meds. And that explains the slow launch and less than stellar scripts.

[biotec]

Exas Cologuard was on the market for only a couple months when the DTC ad's started showing up! I even saw an ad on this site for the non invasive Cologuard! Afrezza needs more Ad's and a big push. Little biotech Exas is doing more without a big partner then MNKD. Look it up! Same Mrk Cap. Way better returns 52 weeks then MNKD. Maybe we should of did a regional roll out? This weeks scripts sucks! JMOA

[notamnkdmillionaire]

Jul 17, 2015 18:29:49 GMT -5 biotec said:

Exas Cologuard was on the market for only a couple months when the DTC ad's started showing up! I even saw an ad on this site for the non invasive Cologuard! Afrezza needs more Ad's and a big push. Little biotech Exas is doing more without a big partner then MNKD. Look it up! Same Mrk Cap. Way better returns 52 weeks then MNKD. Maybe we should of did a regional roll out? This weeks scripts sucks! JMOA

How are more ads going to convince already skeptical doctors to prescribe a medication they don't yet understand? I think Sanofi understand the education part of doctors and insurance companies and getting them on board first is paramount to advertising. 

[biotec]

Jul 17, 2015 18:39:59 GMT -5 notamnkdmillionaire said:

Jul 17, 2015 18:29:49 GMT -5 biotec said:

Exas Cologuard was on the market for only a couple months when the DTC ad's started showing up! I even saw an ad on this site for the non invasive Cologuard! Afrezza needs more Ad's and a big push. Little biotech Exas is doing more without a big partner then MNKD. Look it up! Same Mrk Cap. Way better returns 52 weeks then MNKD. Maybe we should of did a regional roll out? This weeks scripts sucks! JMOA

How are more ads going to convince already skeptical doctors to prescribe a medication they don't yet understand? I think Sanofi understand the education part of doctors and insurance companies and getting them on board first is paramount to advertising. 

Its called DTC and DTD . If more request it, More Doctors will learn about it. If more advertisement helps diabetic learn about Afrezza don't you think Endo's and others in the medical field going to see the same Ad's?

[mrhaigs]

Jul 17, 2015 18:13:32 GMT -5 newmnkdinvestor said:

Jul 17, 2015 18:05:56 GMT -5 mannmade said:

Toujeo does not represent a paradigm shift of seismic proportion as Afrezza does. Toujeo is merely a brand extension of an already existing product (Lantus) and thus has a built in user friendly base of many millions. Afrezza is starting from scratch and requires education on many misunderstood issues such as carb counting.

I agree comparing the two make no sense.



The reason I share my information with the board is because a lot of MNKD longs are expecting big things and soon. That's not happening. I am just trying to temper expectations.

Comparing AWARENESS makes no sense??? I agree comparing sales # makes no sense but I'm not saying that. Becoming aware of afrezza is just easy as becoming aware of toujeo though. Come on guys.

[dreamboatcruise]

Jul 17, 2015 16:30:27 GMT -5 xoxoxoxo said:

So I recently went with my parent who has been a type 2 for about 20 years on insulin for about the past 7 years..    I don't go very often to appointments since I live in a different state.  The only reason I've been involved with Afrezza is because of my parent's issues over the years and being exposed to everything diabetes since I don't have diabetes.

Anyways, this endo is at the cleveland clinic's diabetes center and has been really good and I still think highly of them.  Towards the end of the appointment I asked if they had anyone on Afrezza and they said they just had a scientific presentation on it last week.

However, they haven't prescribed afrezza yet and I basically got a lecture about how they're concerned about the dosing especially the variable dosing between patients.   They then explained that there are a lot of people who aren't candidates because of the lung function testing that's required.  So basically I was pretty disappointed, I really don't think they understand why 8u Afrezza is indicated when the scale says the patient should only have 5-7u.  I'm sure this diabetes centers sees hundreds of patients each week.  

My parent is extremely insulin resistant taking about 60u of levemir each day and 15-20u of novolog on a sliding scale at meals, so I've been waiting until the 12u dosage came out and to get some info from early adopters before I start trying to convince my parent that Afrezza is a good idea.  My parent has relatively poor control because of not testing very often and sometimes forgetting to take insulin.  That's a whole separate challenge which is why I think Afrezza would be a better idea because it's so much easier to take and might improve compliance.

After this I'm convinced our lower than expected script counts is due from doctors being unfamiliar or not hearing about the results/patient success stories.  I wasn't going to argue with the endo about Afrezza, so I just listened and said thank you.  I plan to put some stuff together later this year for my parent to take in after the 12u dosage is available depending on whether he improves.

While the convenience of inhalation may help with compliance, the insulin resistance may, depending on diet, mean that follow up doses of Afrezza would be needed... and for someone that forgets doses in the first place that could be a challenge.  Maybe you could orchestrate a trial when you could be there to help guide through the process with frequent testing and see whether an effective protocol can be established.  Best wishes with the efforts wherever things may go.

[notamnkdmillionaire]

Jul 17, 2015 18:58:54 GMT -5 mrhaigs said:

Jul 17, 2015 18:13:32 GMT -5 newmnkdinvestor said:

I agree comparing the two make no sense.



The reason I share my information with the board is because a lot of MNKD longs are expecting big things and soon. That's not happening. I am just trying to temper expectations.

Comparing AWARENESS makes no sense??? I agree comparing sales # makes no sense but I'm not saying that. Becoming aware of afrezza is just easy as becoming aware of toujeo though. Come on guys.

I am not advocating NOT to advertise but to do so once you know that KOL (aka the docs) understand the drug. I think Sanofi knows this and doesn't want to but the cart before the horse. Why do you think Sanofi hasn't bombard the airwaves already? I'll defer to their expertise in how to market a drug, especially a drug that has existing baggage, warranted or not, as Afrezza?