Michael Monostra , 2025-05-16 13:38:00
Key takeaways:
- Among 35 adults using technosphere insulin in the INHALE-3 trial, 74% increased their daily dose by more than 4 U at 30 weeks.
- Total daily inhaled insulin dose increased from 36 U at 4 days to 52 U at 30 weeks.
ORLANDO — Most patients with type 1 diabetes using an inhaled insulin increased their daily insulin dose by more than 4 U from baseline to 30 weeks, according to data from the INHALE-3 trial.
As Healio previously reported from the American Diabetes Association Scientific Sessions in 2024, technosphere insulin (Afrezza, MannKind Pharma), a rapid-acting insulin delivery through an inhaler, conferred a noninferior HbA1c reduction compared with usual care in adults with type 1 diabetes at 17 weeks. In the INHALE-3 extension study presented at the International Conference on Advanced Technologies & Treatments for Diabetes, significant HbA1c reductions were observed for adults who used technosphere insulin in both the main trial and extension study as well as those who were in the usual care group during the main trial and crossed over to technosphere insulin in the extension study.
Technosphere insulin dosing changed for most participants who used it for 30 weeks in the INHALE-3 trial and extension study. Image: Adobe Stock
According to Jennifer Rittenberry, MD, medical science liaison at MannKind Corp., 4 U, 8 U and 12 U cartridges are available for technosphere insulin. She said participants receiving technosphere insulin in INHALE-3 began the trial with a modified dose of 2 U inhaled insulin for every 1 U rapid-acting insulin they were receiving before the trial.
“[Technosphere insulin] has a unique delivery method, bioavailability and pharmacodynamics, leading to a different clinical effect per unit compared to rapid-acting analogs,” Rittenberry said during a presentation at the American Association of Clinical Endocrinology Annual Scientific and Clinical Conference.
For the AACE presentation, Rittenberry discussed changes in dosing among 35 adults who were randomly assigned to technosphere insulin and completed both the INHALE-3 main trial and extension study with no missed doses (mean age, 46.3 years; 51% women).
Among the study group, total daily technosphere insulin units increased from 36 U at 4 days to 48 U at 17 weeks and 52 U at 30 weeks. The percentage of total insulin that consisted of bolus insulin increased from 60% at 4 days to 65% at 17 weeks and 70% at 30 weeks.
At 17 weeks, 57% of the study group had an increase in technosphere insulin dose of more than 4 U, 17% decreased their dose by more than 4 U and 26% had a dose remaining within 4 U of their starting dose. At 30 weeks, 74% of adults raised their daily technosphere insulin dose by more than 4 U, 9% lowered their dose by more than 4 U and 17% continued with a dose within 4 U of their starting dose.
Technosphere insulin doses increased at all meal times from baseline to 30 weeks. The most common technosphere insulin dose size per meal at both baseline and 30 weeks was 8 U. There were seven adults using a 4 U dose at the start of INHALE-3, but only two adults were using a 4 U dose at 30 weeks, according to Rittenberry.
“By the end of 30 weeks, there were people taking 4 U, but there were a lot of people taking higher doses than that,” Rittenberry said. “8 U, 12 U [and] 16 U were pretty common doses for meals.”
During the main INHALE-3 trial and extension phase, no new safety signals were observed. One severe hypoglycemic event was reported during the extension study in a participant who switched to technosphere insulin after being enrolled in usual care in the main trial. The cause of the event was a delay in starting a meal after a technosphere insulin dose, Rittenberry said. The most common adverse event with technosphere insulin was cough.
“Every patient has individual insulin needs that can change based on meal patterns, physical activity, illnesses or medications,” Rittenberry said during the presentation. “This study helps characterize what typical technosphere insulin doses are.”
Sources/Disclosures
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Rittenberry J. Inhaled insulin dosing in a randomized trial in adults with type 1 diabetes. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 15-17, 2025; Orlando.
Disclosures:
Rittenberry is an employee of MannKind Corp.
