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ADA – Inhaled Insulin AFRESA(R) Controls Post-Meal Sugar Levels with Less Weight Gain and Hypoglycemia

Jun 16, 2009
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The findings of two 52-week studies show that the investigational ultra rapid acting insulin AFRESA® (insulin human [rDNA origin]) Inhalation Powder combined with basal insulin is comparable to standard of care therapies in controlling post-meal blood sugar levels, and also results in significantly less weight gain and risk of hypoglycemia for adult patients with diabetes.

AFRESA is a novel, ultra rapid acting mealtime insulin therapy with an action profile that mimics meal-related early insulin release. Based on an extensive phase 3 clinical program, a New Drug Application (NDA) has been accepted by the U.S. Food and Drug Administration (FDA) requesting approval to market AFRESA Inhalation Powder and the AFRESA Inhaler for use in adult patients with Type 1 and Type 2 diabetes mellitus for the treatment of hyperglycemia. AFRESA is conveniently administered by oral inhalation.

Included in the study were patients with Type 2 diabetes who were inadequately controlled (A1c >7.0% and

A1c was reduced by -0.66% and -0.72% in the TI+G and BPA 70/30 groups, respectively, and the proportion of subjects achieving A1c <7.0% were comparable between treatments (22% vs 27%). One-hour PPG change from baseline after a meal challenge was significantly lower in the TI+G group (37 vs. 54 mg/dL; p<0.0001). TI+G produced significantly less weight gain (0.9 vs. 2.5 kg; p=0.0002) and significantly less mild/moderate (48 percent vs. 69 percent, p<0.001) and severe (4 percent vs. 10 percent, p=0.0066) hypoglycemia compared to the BPA 70/30 group. Mean changes from baseline to week 52 in pulmonary function tests were similar in the two groups.

In the second study, patients with Type 1 diabetes (A1c >7.0% and

Reductions in A1c were comparable in both treatment groups with no significant differences in LAA doses in either group. FPG levels (-35.5 +/- 3.3 vs. -20.6 +/- 3.2, p=0.0012) and 1-hour PPG (20.9 +/- 4.79 vs. 40.5 +/- 4.56, CI=0.0022) values were significantly lower with AFRESA than with RAA. Patients in the AFRESA group lost weight (-0.5 +/- 0.3), while patients in the RAA group gained weight (+1.4 +/- 0.3), with the difference being statistically significant (p<0.0001). Finally, the AFRESA group had a statistically significant reduction in the incidence of mild/moderate (odds ratio [OR] 0.474, confidence interval [CI] 0.271, 0.831; p=0.0091) and total hypoglycemia (OR 0.488; CI 0.278, 0.856; p=0.0124).

Presented at the 69th Annual Scientific Sessions of the American Diabetes Association (ADA) in New Orleans.

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FACT:
Mortality Impact of Intensive Control: New analyses aiming to explain the lack of benefit and apparent mortality increase with tight glucose control in the ACCORD and VADT trials are discussed. Richard Bergenstal, M.D., of the International Diabetes Center at Park Nicollet in Minneapolis, MN, and ADA president-elect of medicine and science, moderated a press conference that presented the findings. At the press conference, researchers revealed no smoking gun for either trial. Hypoglycemia and lower A1c levels themselves did not explain elevated mortality rates seen in diabetes patients treated to a hemoglobin A1c target below the standard 7.0%.According to Dr. Bergenstal, these results reinforce the need for individualized treatment targets. See This Week’s Item 1

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