Exuberant for Exubera

Exuberant for ExuberaFrom the New York Times

An inhaled form of insulin won federal approval..., offering the first alternative to injections for millions of people with diabetes since the drug was introduced in the 1920's.

David Kliff, who takes insulin for his Type 2 diabetes and publishes the Diabetic Investor newsletter about diabetes-related companies, said the inhalation device might be too big and cumbersome to attract users.

"When you extend it, it looks like a bong," Mr. Kliff said. "I can't see somebody whipping this out in public and using it. People with diabetes are sensitive enough as it is."

But Paul Matelis of Miami, who has used the device in clinical trials for seven years, disagreed. "I've used it at the Orange Bowl," he said.

Mr. Matelis, who is 54 and has Type 1 diabetes, said the inhaler is much more convenient than syringes. "It much easier to take a puff than to load up a syringe and inject yourself in a moving vehicle," he said.

They will also still have to prick their fingers to measure their blood sugar levels.

Once continuous transcutaneous measurement is common the true potential of insulin puffs will be realized because diabetics will be able to control themselves at much lower levels of glucose. It seems like one should also be able to have an implanted device that would broadcast glucose levels to the outside.

Analysts predict that Exubera will rapidly become a blockbuster drug, a term used in the industry to describe a treatment with more than $1 billion in annual sales. Ian Sanderson, an industry analyst at SG Cowen, predicted that Exubera, which was also approved in Europe this week, will have $1.8 billion in annual sales worldwide by 2010, including $1.1 billion in the United States.

That estimate is conservative because it assumes that only 12 percent of patients now taking insulin for Type 2 diabetes will switch to Exubera, Mr. Sanderson said. But many patients appear to strongly prefer Exubera, he said.

"I've been astounded at the patient response to Exubera," Mr. Sanderson said.

Mr. Sanderson predicted that Exubera would cost between $120 and $150 a month, roughly comparable to the price of pills taken by some people with Type 2 diabetes but about three times the price of injectable insulin.

How refreshing. An advance that doesn't cost more.