Exit Exubera

Implications: Pfizer failed miserably in its attempt to provide diabetic patients with an easy-to-use inhaled insulin as an alternative to injectable insulin. A product they projected would generate sales of $2 billion a year recorded a disappointing $12 million in sales this year. CEO Kindler said he decided to pull the product to spend shareholders' money more wisely. Perhaps he should have thought about that a little sooner.

Analysis:

 Pfizer's introduction of Exubera, the first inhaled insulin, was a dramatic yet not surprising failure. The debacle was multifactorial.

The product required administration via a complicated, cumbersome inhalation device. The dosing was based on milligrams, not units of insulin, unlike current insulin products. There were pulmonary concerns necessitating spirometry assessments and additional physician visits and medical expense.
 
However, the greatest faux pas, in my estimation, is in the way they marketed the product. They expected physicians to take the time to educate patients on the administration of the drug. Most physicians simply do not have the time to spend to sit down with patients to explain how to administer drugs.

Pfizer's biggest mistake, and I told them this early on, was the fact that they didn't engage pharmacists in the introduction of this product. Pharmacists see their patients more often than any other health care providers and are responsible for managing their drug therapy outcomes. Pharmacists, therefore, are in the best position to educate patients on the indications, use, administration, storage, drug interactions, and side effects of their medications.
 
Had Pfizer provided pharmacists with demonstration inhalers and worked with pharmacists on ensuring the education of patients in regard to the administration of Exubera and compensated pharmacists for those efforts, the launch very possibly could have been successful.

I don't think we have seen the end of inhaled insulin. It is likely that another company, with more forethought, may yet resurrect the product.