EXUBERA: The first inhaled insulin –the hype and the fall

Exubera was supposed to revolutionize diabetes care. It was the first inhalable insulin product on the market, invented by biotech startup Nektar Therapeutics and shepherded to market by drug giant Pfizer. Inhalable Exubera was available from September 2006 to October 2007 in the United States as a new method of delivering insulin. Pfizer made a massive miscalculation about how patients with diabetes manage their disease. What initially attracted the company was the idea that inhaled insulin would offer an alternative to patients afraid to stick themselves with needles multiple times a day. But the needle sticks really were not that much of a hassle and the needles themselves became so thin that they caused virtually no pain.

Exubera was prescribed in milligrams. 1 mg of Exubera is equivalent to 3 units of insulin, however, the increment was not linear: 3 mg of Exubera is equivalent to 8 units of insulin and not 9 units as might be expected. Furthermore, because of retention of blister contents, three consecutive doses of 1 mg blisters of Exubera results in a higher dose of insulin than a single 3 mg blister of Exubera,
further complicating prescribing calculations.

In 2007, Pfizer announced that it will no longer manufacture or market Exubera. Later, in 2008, Pfizer announced Exubera, a powdered form of recombinant human insulin, delivered through an inhaler into the lungs where it is absorbed may be associated with lung cancer. Pfizer's also stated that Nektar had stopped searching for a new marketing partner and withdrew its marketing authorisation around September 2008.