EASD is nuts - there are 1500 people trying to get into 1000-person rooms!
Some early news:
- Lilly and Amylin had a packed room for their symposia on insulin and GLP-1 -- Lilly is in charge of the global launch and it's being introduced currently throughout Europe. The booth was packed throughout the day, as was Merck's - Byetta and Januvia are the newest drugs on the block and it will be fascinating to see how they are taken up and what reimbursement looks like throughout the EU.
- Novo Nordisk also had a day-long symposia (this seems to be a European phenomena) on Monday and this was extremely well-attended. Insulin and liraglutide, of course, were the topics of the day. Dr. Michael Nauck noted that Liraglutide dosing would be available in 0.65, 1.25, and 1.9 mg/day. This might be a little confusing to PCPs although of course choice would be viewed by those that understand the therapy well as a benefit. Weight loss seems dose dependent, starting at 1.25 and above. Novo Nordisk's booth was among the most well-traffic'd on day one, with doctors checking out the full complement of insulins as well as research on lira.
- At the end of day #1, Pfizer released 8-year safety data for Exubera. This was reassuring to see. We are excited for the next generation device. Our take is there were a number of barriers to the first generation but that if safety data continues to look good, inhaled insulin has the potential to lower the population A1c. It's fashionable, of course, to deride the class - from our view, anything that could help patients improve their A1c is a win, and if the therapy can be accessed more simply and easily, it will have a better chance. Clearly, insulin is insulin is insulin and it's hard to teach - no way around that.
- Novartis had an excellent session and note that it would likely see approval for Galvus in the EU shortly - they got some promising feedback in the last couple of months. It is expected to be able to be used with metformin, SFUs, and TZDs - this is a broader label than Januvia has overseas (it does not have SFU label in the EU). We are very impressed at all the work Novartis has done, in particular that it started a five year outcomes study two years ago - so we'll see long term data just three years from now. Very smart and terrific commitment to see from the company.
- The Abbott booth was packed with people vying for a first look at the approved continuous monitoring device Freestyle Navigator. Excitement abounds. The early generations aren't always perfect and we don't expect this to escape early hassles, but it's terrific to see it out and it will be great to watch movement toward the next generation.
Back to the canals of Amsterdam!
Is Exubera still being dosed according to the patient's weight?
Also, despite the safety information, effectiveness is a huge concern. Is there any comparison of patients taking Exubera compared to patients with the same A1c and other characteristics taking Basal/Bolus injected insulin?
My major concern with Exubera has always been that it is a bolus insulin, used at mealtimes, but it cannot be dosed to match the carbohydrate intake of the meal. this means means that tight control is impossible and patients with Type 2 are likely be kept at dangerously high blood sugar levels so as to avoid lows.
If a patient is going to use insulin, wouldn't it be better to put them on the effective basal/bolus regimens that, in combination with carb counting, can normalize blood sugar rather than the random doses that Exubera makes necessary.
Given the huge difference in insulin/carb ratios from person to person, the idea that you can dose by the patient's weight seems like it guarantees most people cannot get good control with this product. Injectable insulin, properly prescribed and with patients who are properly educated CAN provide excellent control.
Posted by: Jenny | 09/18/2007 at 12:52 PM