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Post by esstan2001 on Jan 14, 2016 17:06:36 GMT -5
stevil , I disagree...... I wouldn't piss in their ears if their brains were on fire. Just my opinion of Sanofi, I enjoy reading your professional input. Boycott Sanofi wow I spit up my water when I got to that line :-) |
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Post by agedhippie on Jan 14, 2016 17:08:25 GMT -5
When a sales rep sells it as an inhaled insulin that's all the DR hears and he/she makes a judgement based on whether the inhaled component is worth his time and effort. It should be sold as a system to more closely mimic the pancreas and by the way you don't have to jab yourself with a needle. DR's seem to think that the inhaled piece is just a delivery gimmick. Some in the article did not even realize that Afrezza was a prandial insulin only and made comments as if it were a basal. The basal references are because the standard of care says you use basal insulin before you use prandial insulin. What they were saying was that they were following the agreed standard of care for Type 2 diabetics (Type 1 will be on both). |
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Post by rockstarrick on Jan 14, 2016 17:29:43 GMT -5
stevil , I disagree...... I wouldn't piss in their ears if their brains were on fire. Just my opinion of Sanofi, I enjoy reading your professional input. Boycott Sanofi wow I spit up my water when I got to that line :-) I try to only use that one on special occasions. I'll be good from here on out. Just can't believe I defended those crooks at Sanofi. Go Mannkind |
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Post by bioexec25 on Jan 14, 2016 17:29:50 GMT -5
dictatorsaurus ... very true about getting dumped early. I applaud those that saw through SNY's deception. One will never know what their true intent was when the old CEO did the deal, but I think it is pretty clear that they have long been planning to drop Afrezza. At least we've got some cash and a fighting chance. GD back stabbing Cheese Eating Frogs... LOL Yep agree. Cheese eating surrender monkeys. Anyway, so it's been said but I want to strengthen the point, that when Sny saw the true effect of EARLY adoption of Afrezza along with proper dosing/timing, they saw their a level of cannibalism being equal to Ottis Toole or Jeffrey Dalmer. |
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Post by esstan2001 on Jan 14, 2016 17:38:48 GMT -5
wow I spit up my water when I got to that line :-) I try to only use that one on special occasions. I'll be good from here on out. Just can't believe I defended those crooks at Sanofi. Go Mannkind Well no one can contest that this event was worthy of special occasion status- damn them |
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Post by dudley on Jan 14, 2016 17:41:33 GMT -5
Ok, I had to post this in the main area because at best it's laughable not to mention what lengths they are going to go to to discredit Afrezza. Meet the Doctors of Dinosaurs... who most will hopefully fall to the wayside. www.medpagetoday.com/Cardiology/Type1Diabetes/55663?utm_source=dlvr.it&utm_medium=twitterLast week, drugmaker Sanofi pulled out of its agreement with MannKind Corporation to sell the inhaled insulin product called Afrezza. The device, cleared by the FDA in June of 2014 on its third try, apparently flopped when it hit the market, earning only a few million dollars in 9 months on the market. MedPage Today spoke to several doctors about whether, and why or why not, they prescribed Afrezza. Jennifer Holst, MD, University of Pittsburgh School of Medicine: "I did prescribe Afrezza to some patients. Inhaled insulin is a nice option for some patients with diabetes who prefer to inhale a medication than to inject. This is the second time that inhaled insulin has come out to market, and then been pulled off. Afrezza was much easier to use than the previous inhaled insulin." Lee Green, MD, MPH, University of Michigan Health System: "I never did prescribe it; just didn't see a need for it." Filip Knop, MD, PhD, University of Copenhagen: "I guess the well-established long-term safety of injected insulin outweighs the -- in my opinion -- questionable benefits of inhaled insulin. My patients with diabetes basically NEVER complain about insulin injections. The gauge of modern needles is so small that you basically can't feel the injection. Maybe needle-phobia is a problem among US patients, but -- really(!) -- it's not a problem that my patients mention very often -- despite my often asking them." Howard Weintraub, MD, New York University Langone Medical Center: "I have not used inhaled insulin. I have been more comfortable with basal insulin preparations. This would not represent any major loss for me or any of my patients." David Armstrong, MD, PhD, University of Arizona College of Medicine: "I know about this and it is an enormous shame. This is a drug with wonderful promise that will now not likely be realized. As a surgeon who specializes in preventing some of the end stage complications of this disease, I do not have occasion to prescribe it, but I do see the devastating results of diabetes and therefore am something of a customer myself!" Joel Zonszein, MD, Albert Einstein College of Medicine: "I was perplexed when Sanofi made the decision to market it and I hope they've learn a lesson. As a clinician that treat individuals with diabetes I can attest that inhaled insulins, no matter how good ... have only a small place, if at all, in the current market.
"Inhaled insulins are not good for management of type 1 diabetes (where a basal and prandial regimens needs to be properly crafted for each patient by either multiple injections or CIIS pumps). Inhaled insulins are not good for T2DM as these patients need a basal regimen ... The pen syringes and needles used nowadays are excellent and almost painless -- thus, there is no need for inhaled insulins to replace these.
"Physicians often have a dark cloud in their mind with regards to large amounts of insulin in the lungs and if they can cause malignancy after years of use. There are also issues with the inhaled insulin as far as problems with the lungs, bronchitis, asthma, pulmonary function, etc."
This Zonszein quote to me borders on malfeasance and/or libel. "no matter how good have only a small place, if at all " Good grief, I would not want to be his patient. "Sure, I know about something really, really good but no matter how good it is I am not going to let you have it." Furthermore, there is a complete lack of any evidence at all after thousands and thousands of patient hours in trials, real world user experience, and countless lab tests of ANY sort of lung issues. For someone to make a statement like his smacks of almost criminal intent to defame since he has no basis whatsoever to make a statement like that. How can "physicians often have a dark cloud in their mind" over something that apparently nobody knows about? While I am on this rant, how about Sanofi's complete neglect in pointing this out? The lack of any evidence at all of lung issues is something that can and should be disclosed. Mannkind has all the test info from their extensive research in Technosphere and Afrezza readily available to back up the statement. There are thousands of patients that Sanofi followed - never a report of any lung issues. I would hope Matt would find a way to circulate this evidence and counteract these idiots making those statements. I hope they come out swinging in their new bold and assertive version 2.0. How about Sanofi's complete neglect in following up on results that clearly show Afrezza was generating unheard of favorable results in real life patients? Any entity realistically concerned about marketing a product successfully would take that up with a frenzy - it is true marketing nirvana to see something like that. They should have started superiority trials as soon as they saw the early adopter results materializing. Borders on gross negligence and complete abdication of their responsibilities as THE SOLE MARKETING AGENT. |
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Post by LosingMyBullishness on Jan 14, 2016 17:48:50 GMT -5
Not very surprising comment from Filip Knop from København, Denmark. It takes about 20min to drive from the Københavns Universitet to the Headquarters of Novo Nordisk A/S. Novo Nordisk sponsors institutes etc. 0,3 % of the total danish mainland population work for Novo Nordisk directly. It is the 5th largest danish company by turnover.
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Post by mnholdem on Jan 14, 2016 18:37:23 GMT -5
Some in the article did not even realize that Afrezza was a prandial insulin only and made comments as if it were a basal. The basal references are because the standard of care says you use basal insulin before you use prandial insulin. What they were saying was that they were following the agreed standard of care for Type 2 diabetics (Type 1 will be on both). Afrezza marketing has yet to emphasize that it is a monomer insulin that the body can rapidly put to work to control blood glucose. |
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Post by agedhippie on Jan 14, 2016 19:10:11 GMT -5
The basal references are because the standard of care says you use basal insulin before you use prandial insulin. What they were saying was that they were following the agreed standard of care for Type 2 diabetics (Type 1 will be on both). Afrezza marketing has yet to emphasize that it is a monomer insulin that the body can rapidly put to work to control blood glucose. That's the crux of the problem. You can highlight that, but the standard of care says basal and not prandial insulin as the first insulin measure for Type 2. It is difficult to get doctors to ignore the standard of care for a disease. If the trial data supported it there may be a chance, but at the moment it says Afrezza behaves slightly worse than Humalog or Novolog. There need to be new trials, but they are very expensive and take time. |
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Post by peppy on Jan 14, 2016 19:17:42 GMT -5
Afrezza marketing has yet to emphasize that it is a monomer insulin that the body can rapidly put to work to control blood glucose. That's the crux of the problem. You can highlight that, but the standard of care says basal and not prandial insulin as the first insulin measure for Type 2. It is difficult to get doctors to ignore the standard of care for a disease. If the trial data supported it there may be a chance, but at the moment it says Afrezza behaves slightly worse than Humalog or Novolog. There need to be new trials, but they are very expensive and take time. We have type 2 on this board, on basal and afrezza the prandial. once mealtime insulin is added, the choice can be made which mealtime. The person had their basal insulin lowered twice. Once when starting afrezza, once after fasting blood sugars too low for a few days.
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Post by ricguy on Jan 14, 2016 19:30:52 GMT -5
How or why these docs have those opinions isn't the issue.... How to CHANGE those opinions is now the issue, and it currently sits with MNKD alone. Those opinions are the general consensus of docs & endo's across the country, and that's if they even know what Afrezza is. If this past year was an "educational" campaign by SNY, then they have failed more miserably than we realize. I PRAY that SNY has intentionally sandbagged Afrezza to either negotiate a better price now, or to try to kill it permanently, because if not, and they actually gave an effort, then MNKD is done. There is no way MNKD can change the current dialog alone. If they don't figure out how or why docs feel the way they do, they won't have much success changing it. If SNY did do an educational campaign and really put forth the effort I agree with you, this will be tough, a superior label would be a huge help to get the push from Docs. This might come down to patient driven demand if the word on Afrezza can keep reaching more patients. Maybe Adam Lasher will win American Idol and will hoist the Dreamboat on Live TV :-) GLTU. |
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Post by agedhippie on Jan 14, 2016 19:47:05 GMT -5
That's the crux of the problem. You can highlight that, but the standard of care says basal and not prandial insulin as the first insulin measure for Type 2. It is difficult to get doctors to ignore the standard of care for a disease. If the trial data supported it there may be a chance, but at the moment it says Afrezza behaves slightly worse than Humalog or Novolog. There need to be new trials, but they are very expensive and take time. We have type 2 on this board, on basal and afrezza the prandial. once mealtime insulin is added, the choice can be made which mealtime. The person had their basal insulin lowered twice. Once when starting afrezza, once after fasting blood sugars too low for a few days.
I can believe that. The standard of care says that once basal alone fails you should add prandial insulin as well. That is the ideal time to add Afrezza because that's when the doctor will have the least resistance as the patient is not already on prandial insulin (they are not swapping them the insulin) and it needs to be added. It is not uncommon for the basal insulin to be lowered at that point because typically (and incorrectly) some of the basal has been used to cover meals. Now meals are being correctly covered that extra basal can be dropped. You could probably change that ratio even further towards Afrezza by doing proper fasted basal testing. |
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Post by sportsrancho on Jan 14, 2016 19:50:17 GMT -5
When a sales rep sells it as an inhaled insulin that's all the DR hears and he/she makes a judgement based on whether the inhaled component is worth his time and effort. It should be sold as a system to more closely mimic the pancreas and by the way you don't have to jab yourself with a needle. DR's seem to think that the inhaled piece is just a delivery gimmick. In my world there was no selling going on. There was no talking going on! The reps just dropped the pamphlets off at the front desk! And that was only last month. |
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Post by nadathing on Jan 14, 2016 19:56:01 GMT -5
Some doctors are lazy. Some are overworked and unable to keep up with new treatments. Others are afraid of new technologies. I've posted here before that my doctor was reluctant to prescribe Bydureon for me because of the label, even though I had been on a 3 year P3 trial and had excellent results. The P3 trial was at The international Diabetes Center which is in the same system as my doctor is in and the buildings are adjacent to each other. I demanded Bydureon and she prescribed it. Afrezza must be patient drive. I think MNKD is on the right path.
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Post by stevil on Jan 14, 2016 19:57:52 GMT -5
factspls88 - I'm not sure about the writer but they also have it listed under Cardiology stevil - I know a few doctors and have seen first hand on how they can be biased towards certain companies/treatments as some do research, speeches, etc and are compensated. So don't bite the hand that feeds as they say. I wouldn't debate that point with you at all. I believe that you are speaking the truth. I'm just saying the vast majority of physicians are not unethical to this degree and truly seek their patient's well-being. It is still a solid profession. The only way the argument that docs are avoiding Afrezza because they don't want it to cut into their business can hold water is if SNY specifically targeted the docs in their back pocket. This clearly did not happen, at least not exclusively. There have been several docs that have become enamored with it. Also, it is now illegal, as Liane has even testified, that any kind of kickbacks are illegal. I'm not sure if your story is recent, but even if it is, this could not be a widespread phenomenon. There is way too much risk involved. If a manufacturer ever got caught paying off docs, I'm sure the FDA or whoever the governing body is would make their punishment so immensely severe as to make a poster child out of them. They'd have to. |
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