T2D: PROVEN CONTROL

Proven to significantly reduce A1C levels1,2

INSULIN-NAÏVE STUDY: ACHIEVEMENT OF A1C ≤7% WITH AFREZZA1

Data from a 24-week, randomized, double-blind, placebo-controlled, multicenter trial of insulin-naïve adults with T2D (n=353) uncontrolled (A1C >7.5% to 10%) on optimal/maximal tolerated doses of either metformin alone or ≥2 oral agents (OAs). Patients were treated with Afrezza plus OAs or inhaled placebo powder without insulin plus OAs. Baseline A1C levels for Afrezza+OAs and placebo+OAs were 8.25% and 8.27%, respectively. Change from baseline (adjusted mean) A1C levels were -0.82% and -0.42%, respectively.2

  • For insulin-naïve patients currently taking OAs, the addition of Afrezza as mealtime insulin significantly reduced A1C levels from baseline compared with inhaled placebo (–0.82% versus –0.42%; treatment difference, –0.40%; P<0.0001)1,2
  • Significantly more Afrezza-treated subjects reached A1C ≤6.5% compared with placebo-treated subjects (13.6% versus 3.4%; P=0.0021)2
  • Patients on Afrezza had slight weight gain as compared with orals alone (+0.49 kg versus –1.13 kg)2

Proven A1C reduction in patients inadequately controlled3

REAL-WORLD STUDY: CHANGE IN A1C LEVELS OVER TREATMENT COURSE3

Data from a real-world practice setting trial of patients with T2D (n=20) inadequately controlled (A1C 7.5% to 11.5%) after at least 6 months of other diabetes treatments, including OAs and basal insulin. Afrezza treatment was added to each patient’s current therapy, administered before each meal, and titrated per protocol. A1C and blinded CGM measurements were recorded while patients continued to self-monitor blood glucoses daily.3

  • The mean A1C decline with the addition of Afrezza was –1.6%3
  • 90% of patients (18/20) achieved A1C levels of <8%4
  • Afrezza was titrated to a dose of approximately 20 units per meal by the end of the study3

Improvement of TIR3*

REAL-WORLD STUDY: CHANGE IN TIR OVER 12 WEEKS OF TREATMENT WITH AFREZZA3

Data from a real-world practice setting trial of patients with T2D (n=20) inadequately controlled (A1C 7.5% to 11.5%) after at least 6 months of other diabetes treatments, including OAs and basal insulin. Afrezza treatment was added to each patient’s current therapy, administered before each meal, and titrated per protocol. A1C and blinded CGM measurements were recorded while patients continued to self-monitor blood glucoses daily.3

*Relative increase from 42.2% to 65.7% equals 55.7%. Baseline TIR (42.2%) equates to about 10 hours TIR, which increased over 12 weeks to 65.7%, equating to about 16 hours TIR at the end of the study, for an approximate increase of 6 hours TIR per day.3

  • Mean daily blood glucose levels decreased by 41 mg/dL (P<0.0002), which was equivalent to a 20% relative decrease3

Weight-neutral profile in T2D 4

CROSS-STUDY ANALYSIS: WEIGHT CHANGE FROM BASELINE WITH AFREZZA4

weight-neutra-ls

Data from 2 clinical trials of Afrezza in patients with T2D where LS mean change in weight from baseline to week 24 (aspart) or week 26 (biaspart) for the intention-to-treat populations were compared. The weight change in the Afrezza groups for each clinical study was –0.78 kg and +0.24 kg, respectively. Since data are from separate trials, they should be interpreted cautiously.4

  • In individuals with T2D, treatment with Afrezza was associated with a weight-neutral profile as compared with insulin aspart or biaspart insulin4
  • This change was independent of the change in glucose control4

References: 1. Afrezza (insulin human) Inhalation Powder Prescribing Information. MannKind Corporation. 2. Rosenstock J, Franco D, Korpachev V, et al. Inhaled Technosphere insulin versus inhaled Technosphere placebo in insulin-naïve subjects with type 2 diabetes inadequately controlled on oral antidiabetes agent. Diabetes Care. 2015;38(12):2274-2281. 3. Levin P, Hoogwerf BJ, Snell-Bergeon J, et al. Ultra rapid-acting inhaled insulin improves glucose control in patients with type 2 diabetes mellitus. Endocr Pract. 2021;27(5):449-454. 4. Data on file. MannKind Corporation.

US-AFR-1670

Important Safety Information  for AFREZZA® (insulin human) Inhalation Powder

WARNING: RISK OF ACUTE BRONCHOSPASM IN PATIENTS WITH CHRONIC LUNG DISEASE. Acute bronchospasm has been observed in patients with asthma and COPD using AFREZZA. AFREZZA is contraindicated in patients with chronic lung disease such as asthma or COPD. Before initiating AFREZZA, perform a detailed medical history, physical examination, and spirometry (FEV1) to identify potential lung disease in all patients.

Important Safety Information

Indications and Usage:

Afrezza® (insulin human) Inhalation Powder is a rapid-acting inhaled insulin indicated to improve glycemic control in adult patients with diabetes mellitus.

Limitations of Use: Patients with type 1 diabetes must use with a long-acting insulin, not recommended for the treatment of diabetic ketoacidosis, not recommended in patients who smoke.

WARNING: RISK OF ACUTE BRONCHOSPASM IN PATIENTS WITH CHRONIC LUNG DISEASE

  • Acute bronchospasm has been observed in patients with asthma and COPD using AFREZZA.
  • AFREZZA is contraindicated in patients with chronic lung disease such as asthma or COPD.
  • Before initiating AFREZZA, perform a detailed medical history, physical examination, and spirometry (FEV1) to identify potential lung disease in all patients.

 

Contraindications

AFREZZA is contraindicated: during episodes of hypoglycemia, in patients with chronic lung disease (such as asthma or chronic obstructive pulmonary disease [COPD]) because of the risk of acute bronchospasm, and in patients with hypersensitivity to regular human insulin or any of the AFREZZA excipients.

Warnings and Precautions
Acute Bronchospasm: Acute bronchospasm has been observed following AFREZZA dosing in patients with asthma and COPD. Prior to initiating therapy, evaluate patients with a medical history, physical examination, and spirometry (FEV1) to identify potential underlying lung disease. Do not use in patients with COPD.

Change in Insulin Regimen: Monitor blood glucose in all patients treated with insulin. Modify insulin regimen and dose cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment.

Hypoglycemia: Hypoglycemia is the most common adverse reaction of insulin therapy, including AFREZZA, and may be serious and life-threatening. Educate patients and caregivers on recognizing symptoms and mitigating the risks associated with hypoglycemia.

Decline in Pulmonary Function: AFREZZA has been shown to cause a decrease in lung function as measured by FEV1. In clinical trials lasting up to 2 years, AFREZZA-treated patients experienced a small (40 mL) but greater FEV1 decline than comparator-treated patients. Assess pulmonary function with spirometry at baseline, after the initial 6 months of therapy and annually thereafter even in the absence of pulmonary symptoms. In patients who have a decline of ≥20% in FEV1 from baseline, consider discontinuing AFREZZA. Consider more frequent lung function assessment in patients with pulmonary symptoms, e.g., wheezing, bronchospasm, breathing difficulties, or persistent or recurring cough. If symptoms persist, discontinue AFREZZA.

Lung Cancer: In clinical trials, 2 cases of lung cancer were reported in patients exposed to AFREZZA while no cases were reported for the comparators. Two additional cases of lung cancer (squamous cell and lung blastoma) were reported in non-smokers exposed to AFREZZA after the trial completion. These data are insufficient to determine whether AFREZZA has an effect on lung or respiratory tract tumors. In patients with active lung cancer, a prior history of lung cancer, or in patients at risk of lung cancer, consider whether the benefits of AFREZZA outweigh the risks.

Diabetic Ketoacidosis (DKA): In clinical trials enrolling subjects with type 1 diabetes, diabetic ketoacidosis (DKA) was more common in subjects receiving AFREZZA (0.43%; n=13) than in subjects receiving comparators (0.14%; n=3). Increase the frequency of glucose monitoring and consider an alternate route of administration of insulin in patients at risk for DKA.

Hypersensitivity Reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue AFREZZA, monitor, and treat if indicated.

Hypokalemia: All insulin products, including AFREZZA, cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Closely monitor potassium levels in patients at risk of hypokalemia and treat if indicated.

Fluid Retention and Heart Failure with Concomitant Use of Thiazolidinediones (TZDs): Fluid retention, which may lead to or exacerbate heart failure, can occur with concomitant use of TZDs and insulin. Observe these patients for signs and symptoms of heart failure. If heart failure occurs, consider dose reduction or discontinuation of TZD.

Drug Interactions
Certain drugs may affect glucose metabolism, increasing the risk of hypoglycemia or decreasing the blood glucose–lowering effect of AFREZZA. Dose adjustment and increased frequency of blood glucose monitoring may be required. Co-administration of beta-blockers, clonidine, guanethidine, and reserpine with AFREZZA may reduce the signs and symptoms of hypoglycemia. For full list, see Prescribing Information.

Adverse Reactions
The most common adverse reactions associated with AFREZZA include hypoglycemia, cough, and throat pain or irritation.

Please see full Prescribing Information, including BOXED WARNING for AFREZZA.

AFREZZA, MANNKIND, and the Afrezza and MannKind logos are registered trademarks, and AFREZZAASSIST, AfrezzaAssist and logo are mark applications, all owned by MannKind Corporation. © MannKind Corporation 2021. This site is intended for use by US healthcare professionals only.

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