Pfizer Markets First Insulin Inhaler for Diabetics
Yesterday, Pfizer announced it would be rolling out Exubera in the U.S. beginning in September, following an educational campaign to assist with early uptake. In related news, Nektar, which receives revenues from manufacturing Exubera and royalties on sales, raised its its first-year revenue guidance from Exubera by $10 million (12 to 17%). As Nektar’s guidance depends largely on orders placed by Pfizer, the raised guidance suggests that Pfizer has become more optimistic about initial uptake of the drug.
This will certainly be one of the more interesting product launches in diabetes care ever. I’m intrigued by competing factors clinicians, patients, and third-party payers will weigh when deciding to use/reimburse for the drug: convenience (multiple injections vs. multiple inhalations; syringes and needles vs. an inhalation device), dose tailoring (extreme flexibility vs. limited flexibility), cost (3x to 5x higher for Exubera), toxicity (an increased risk of lung toxicity and lung function testing before use for Exubera), and Pfizer’s powerful position in the industry. It’s clear from the comparison, that Pfizer must highlight the convenience and purported QOL benefits (which NICE rejected–see my PCE post from June) of Exubera, as these are the points of relative advantage. To do so, they will likely use the same arguments we saw used in the NICE appraisal, albeit magnified in extreme proportion by thousands of salespeople, medical affairs physicians, and “medical science liasions” in the field. Will they succeed? We shall soon see. Oh…you’d like me to put my opinion on the line? Fine. There likley exists a decent-sized pool of insulin users that is eagerly anticipating launch of the drug. These users will be identified via Pfizer’s rollout campaigns and will contribute the vast majority of initial sales. Following satisfaction of this pool in the first 2 to 3 months, uptake of Exubera will trace a curve similar to the early uptake of Lantus. The time until and magnitude of peak sales will depend largely on patient satisfaction with the device/drug relative to the injections. Again, we shall soon see.
