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Post by agedhippie on Feb 26, 2023 10:20:26 GMT -5
Is that monitoring the swipe of a phone ? No, that's reading the result. Monitoring is making the decision to pick up the phone and check.
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Post by agedhippie on Feb 25, 2023 22:50:26 GMT -5
Aged - here is the reality, there is no algorithm which Lance can write which will ever have the AID beat afrezza at 60minutes, 90minutes and I doubt 120 minutes. Al could not do it and Lane certainly is not. I do give Lance a lot of credit for deciding to work with MNKD. I think the MTTD work he is doing is very valuable. ... True, but it's just a meal. In the context of this data Afrezza will always win because you have a standard meal with no carbs already onboard - it's a very clean and simple use case. The real world is messy - I might have been snacking, had a coffee, still had the remains of an old meal (or two) in my system, been stressed, and so on. That's why AID matters because it can clean up that for you so your TIR is into the mid 70%. If I am just on Afrezza this is a problem because I need to perform that monitoring and dosing that the algorithm is doing automatically by hand and that's a lot of work! Real world numbers are what matter - it's why for me (although not so much the ADA!) things like the real world 780G numbers are so impressive.
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Post by agedhippie on Feb 25, 2023 22:35:59 GMT -5
Feel free to correct me if I am not answering the question you are asking peppy. It reads like you are asking why these two RAA insulins have different PK/PD but are treated the same. I think the answer is because (and i have used both over the years) outside the lab they are effectively the same and their PK/PD vary from person to person. For me both have a noticeable tail out to six hours with 10% left at 5 hours. Endos believe the official PK/PD, diabetics know that it is highly individualized, but it should be in the ballpark. The variance is sufficiently small that you don't notice it and I say that as someone who fought tooth and nail when Aetna went Humalog only. There is an RAA from Sanofi called Apidra out there which apparently (I have never used it although I would like to have) is noticeably faster even if only marginally so according to people I trust. It was a popular pump insulin for those that could get insurance coverage which is very restricted.
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Post by agedhippie on Feb 25, 2023 22:14:15 GMT -5
I assume you mean to make an Icodec DPI since there is no way Mannkind could afford to buy Icodec. ... I meant MannKind buy Icodec. How much would that cost them? I don't really know, but given that it's a replacement for Tresiba and the first weekly basal into the market I would think we are comfortably into the billions. Realistically they would not sell because it currently looks like their strongest seller and the basis of other products like Icodec and GLP-1 (in trials, but some way out) At this point their play book is going to be the same as Sanofi with Toujeo and Lantus - replace the older insulin with the newer one at the same price to maintain their edge. There is a Lilly weekly insulin in phase 3 trials at the moment I believe so NVO cannot afford to concede this territory.
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Post by agedhippie on Feb 25, 2023 16:34:47 GMT -5
MannKind to Give Oral Presentation on Meal Challenge Results From the Afrezza® With Basal Combination (ABC Study) at 16th Annual ATTD Conference today 2/25/23. Has any listened to this? I can't locate I don't think anything other than the abstract is available yet. Or rather I haven't been able to find a recording or transcript either!
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Post by agedhippie on Feb 25, 2023 16:33:24 GMT -5
I realized I didn't answer the first part of that post! The graph curves are the same except that they are cut off after 2 hours unlike the STAT graph which ran for five hours. This was using a standardized meal under lab conditions, STAT was real world so the meal were wherever and anything but standardized You attach way to much importance to Nudge BG performing a consultancy engagement with Mannkind. If you hire an industry expert consultant that doesn't mean they are working with you beyond that engagement (or I am working for a ton of companies!) The stat showed how fearful type ones were to take a follow dose. You know afrezza needs the one hour follow up dose. There is an assumption there that it was fear rather than not being bothered. In my experience apathy is a more likely reason given that Type 1s routinely do correction doses with RAA. This comes back to my comment about not wanting something where I had to routinely do follow up doses because it got in the way of my life - I know I am not going to do it. This is also why I am interested in the ABC arm that uses insulin once with the meal and then lets the AID system clean up the leftovers.
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Post by agedhippie on Feb 25, 2023 16:19:53 GMT -5
Good morning: Wondering what the comparative costs are between Afrezza and other treatment regiments. I look at last weeks numbers 1.74M for 836 prescriptions, or $2081 per prescription. I am working with the idea that this is a 3 month / 90 day, so daily cost is $23.12 on average. Is this a correct starting cost for a patient? Anyone care to take a jab at what the other competitors are charging? Including required supplies? Thanks in Advance, OOG Taking just pens and ignoring vials the same numbers for : - Humalog is: $49.93M for 51750 prescriptions, or $964 per prescription. So using the same assumption that is a daily cost of $10.72 on average. - Novolog is: $73.98M for 71560 prescriptions, or $1,033 per prescription. Giving a daily cost of $11.48 on average. Out of curiosity I did the numbers for some of the non-insulin injectables : - Ozempic (excluding Wegovy and Rybelsus to get just the diabetes number): $569.15M for 386.66k prescriptions or $1,471 per prescription. Giving a daily cost of $16.35 on average. - Trulicity is: $408.24M for 274.01k prescriptions, or $1,489 per prescription. Giving a daily cost of $16.55 on average. Trulicity and Ozempic are roughly the same cost so they are probably right. I looked at Mounjaro, but the numbers came out unreasonably low ($1,286) which makes me think there are a lot of monthly prescriptions in there since it's still so new. None of these numbers include needles, but at this point that cost is a rounding error (it's cents) These are all Symphony numbers via Bloomberg so the source is consistent with the Afrezza numbers.
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Post by agedhippie on Feb 25, 2023 15:30:34 GMT -5
Correct - Mike said they were holding the main data for ADA2023. This is only afrezza with AID and AID without afrezza. This does not include Tresiba. What we can say is the graphs they presented are nothing like the graph you referred to earlier in the thread from STAT. I guess I can also say it makes sense Lance is now working with MNKD. There is no way he can write an alogorithm to beat this. ... I realized I didn't answer the first part of that post! The graph curves are the same except that they are cut off after 2 hours unlike the STAT graph which ran for five hours. This was using a standardized meal under lab conditions, STAT was real world so the meal were wherever and anything but standardized You attach way to much importance to Nudge BG performing a consultancy engagement with Mannkind. If you hire an industry expert consultant that doesn't mean they are working with you beyond that engagement (or I am working for a ton of companies!)
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Post by agedhippie on Feb 25, 2023 15:18:48 GMT -5
... It's quite possible for the pump to issue more insulin and chase the curve, but now you have all the insulin you need plus an extra dose - that's the sort of stacking that causes hypos as they now would have far to much insulin in your system.You use a pen. You have control of how much insulin you have on board when. It would seem you prefer control of your own insulin determination. Both the pump and I agree - if I have enough insulin onboard to cover the meal I should not take more to chase the curve. TBH though, sometimes I will stack because I know that before my levels drop badly I will have eaten again - think of it as long range pre-bolusing! But just to chase the curve? No.
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Post by agedhippie on Feb 25, 2023 15:00:49 GMT -5
Lol. Oh look - it's the Afrezza dose with AID system arm of ABC! There were no commercial AID systems 10 years (their algorithm ran on a laptop!) and you can probably get even better results now. I am interested to see how that single dose at the start of a meal with the AID system covering everything else works.
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Post by agedhippie on Feb 25, 2023 14:18:01 GMT -5
... I think if Novo approached MannKind and just wanted to make a Fiasp DPI, MannKind would be better served to counter offer for Novo’s Icodec or strike a partnership to promote Afrezza + Icodec. I assume you mean to make an Icodec DPI since there is no way Mannkind could afford to buy Icodec. Making Icodec DPI is a non-starter since the mechanism that makes icodec last a week (or Tresiba last a day) breaks down in the blood hence the administration restrictions on the Tresiba label.
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Post by agedhippie on Feb 25, 2023 14:11:37 GMT -5
Mango - C256H381N65079S6 is bundled as a hexamer to stabilize it the same as C257H383N65O77S6 was a hexamer until it was put on Technosphere as a monomer. Once C256H381N65079S6 is put on TS it would need the same additives as afrezza. All that stuff in Fiasp would go poof. Its mostly there to try and speed up absorption. The absorption for insulin aspart as a monomer on TS should be about the same as insulin human on TS and it should get to the deep lung just like afrezza. I am not understanding "MannKind would be better served to counter offer for Novo’s Icodec". I think Mike is trying to do something now with afrezza and icodec but I don't know how interested NVO is in working with MNKD. To do the proper trials requires money which MNKD may not have or want to spend. The best case is NVO is interested in afrezza but I doubt it but I hope I am wrong. If I am right and I was Mike, I would pitch putting aspart on TS an follow the UTHR model. Hexamers are only a problem until they hit the bloodstream as it converts in seconds. The problem is the movement of the hexamers through the subq layer and TS bypasses that (as do embedded pumps but they are very rare.) You can happily use RAA in an IV with exactly the same outcome as human insulin (I have seen it done - long story.) There is also a mechanic where you inject into a muscle and then it's fast (not as fast as IV, but only a few minutes) and it hurts a lot! The upshot of that is that you could add RAA to TS, but it's pretty pointless since the outcome would be the same. The part of the insulin molecule that has been modified was changed to accelerate passage through the sunq layer - and if you add RAA to TS that becomes redundant. In other words there is no reason for NVO to put aspart on TS, they may as well use Novolin R (human insulin) as it's a lot cheaper. At that point you are better off just selling Afrezza since that is Afrezza (TS + human insulin) to NVO which would be nice, but isn't going to happen.
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Post by agedhippie on Feb 25, 2023 13:35:25 GMT -5
... At the 2hr mark there is a really significant difference between TI+AID vs AID alone - about 50mg/dl. Thats surprising to me that AID still had not caught up at 2hrs. I think the difference between this and Dave Kendall's STAT was the dosing and of course help of the AID after 90 minutes. For this they based the afrezza dosing on doubling the RAA dose and rounding down. ... The curve for RAA is well established so the results from the AID are exactly as expected. Since the pump has delivered insulin for the food when the person ate and that insulin is still active the pump is simply maintaining the basal. It's quite possible for the pump to issue more insulin and chase the curve, but now you have all the insulin you need plus an extra dose - that's the sort of stacking that causes hypos as they now would have far to much insulin in your system.
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Post by agedhippie on Feb 25, 2023 13:20:17 GMT -5
A different link to the same thing: www.liebertpub.com/doi/full/10.1089/dia.2023.2525.abstractsSearch for Mannkind, there is only one hit and that's the one you want. To be clear; this presentation is not the results from ABC, it's just the results from one part of that trial. There is more to come....
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Post by agedhippie on Feb 25, 2023 10:22:24 GMT -5
Options are from Yahoo Finance. IF you can't find them then we have a real dilemma. LOL. Yes, I will have dilemma as PPS goes up to 6, 7 or even teen..... The interesting one will be $7.50 because at $7.61 (assuming no more dilution) Mannkind becomes a midcap and that means being in the midcap trackers and so a nice bump as the Blackrock, Vanguard, and State Streets buy for their ETFs and trackers.
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