AUTHOR OF THIS BLOG

DR ANTHONY MELVIN CRASTO, WORLDDRUGTRACKER
Nov 022013
 

 

 

TEVETEN® (eprosartan mesylate) is a non-biphenyl non-tetrazole angiotensin II receptor (AT1) antagonist. A selective non-peptide molecule, TEVETEN® is chemically described as the monomethanesulfonate of (E)-2-butyl-1 -(p-carboxybenzyl)-α-2-thienylmethylimid-azole-5 -acrylic acid.

Its empirical formula is C23H24N2O4S•CH4O3S and molecular weight is 520.625. Its structural formula is:

Teveten (Eprosartan Mesylate) Structural Formula Illustration

EPROSARTAN MESYLATE

tevetenEprosartan mesilate, SK&F-108566-J(?, SK&F-108566, Teveten SB, Navixen, Regulaten, Tevetenz, Teveten

US 5656650 exp Aug 12, 2014

CAS EPROSARTAN

144143-96-4 

133040-01-4 

Chemical Name: Eprosartan mesylate
Synonyms: EPROSARTAN MESYLATE;Eprosartan Methanesulfonate;4-[[2-butyl-5-(2-carboxy-3-thiophen-2-yl-prop-1-enyl)-imidazol-1-yl]methyl]benzoic acid mesylate;4-({2-butyl-5-[(1E)-2-carboxy-2-(thiophen-2-ylMethyl)eth-1-en-1-yl]-1H-iMidazol-1-yl}Methyl)benzoic acid;(E)-α-[[2-Butyl-1-[(4-carboxyphenyl)Methyl]-1H-iMidazol-5-yl]Methylene]-2-thiophenepropanoic Acid Methanesulfonate;(αE)-α-[[2-Butyl-1-[(4-carboxyphenyl)Methyl]-1H-iMidazol-5-yl]Methylene]-2-thiophenepropanoic Acid MonoMethanesulfonate
CBNumber: CB4842192
Molecular Formula: C24H28N2O7S2
Formula Weight: 520.61832

 

Eprosartan is an angiotensin II receptor antagonist used for the treatment of high blood pressure. It is marketed as Teveten byAbbott Laboratories in the United States.It is marketed as Eprozar by INTAS Pharmaceuticals in India and by Abbott Laboratorieselsewhere. It is sometimes paired with hydrochlorothiazide, marketed in the US as Teveten HCT and elsewhere as TevetenPlus.

The drug acts on the renin-angiotensin system in two ways to decrease total peripheral resistance. First, it blocks the binding ofangiotensin II to AT1 receptors in vascular smooth muscle, causing vascular dilatation. Second, it inhibits sympatheticnorepinephrine production, further reducing blood pressure.

As with other angiotensin II receptor antagonists, eprosartan is generally better tolerated than enalapril (an ACE inhibitor), especially among the elderly.[1]

Eprosartan is an angiotensin II receptor antagonist used for the treatment of high blood pressure. It acts on the renin-angiotensin system in two ways to decrease total peripheral resistance. First, it blocks the binding of angiotensin II to AT1 receptors in vascular smooth muscle, causing vascular dilatation. Second, it inhibits sympathetic norepinephrine production, further reducing blood pressure.

  1.  Ruilope L, Jäger B, Prichard B (2001). “Eprosartan versus enalapril in elderly patients with hypertension: a double-blind, randomized trial”. Blood Press. 10 (4): 223–9. doi:10.1080/08037050152669747PMID 11800061.

PAT            APR                EXP

Canada 2250395 2005-09-06 2017-03-26
Canada 2115170 2004-05-25 2012-08-12
United States 5656650 1994-08-12 2014-08-12
United States 5185351 1993-02-09 2010-02-09
Canada 2115170 2004-05-25 2012-08-12
United States 5656650 1994-08-12 2014-08-12
Canada 2250395 2005-09-06 2017-03-26

J Med Chem1991,34,(4):1514-7

J Med Chem1993,36,(13):1880-92

Synth Commun1993,23,(22):3231-48

AU 9056901, EP 403159, JP 91115278, US 5185351.

Drugs Fut1997,22,(10):1079

 

Eprosartan mesylate was developed successfully by SmithKline Beecham Corporation in 1997, and marketed in Germany in 1998 under the trade-name Teveten and in the United States later in 1999. Eprosartan mesylate, as an angiotensin II receptor blocker, is an antihypertensive drug of the latest generation. Eprosartan mesylate is potent to lower systolic and diastolic pressures in mild, moderate and severe hypertensive patients, and is safe and tolerable. Eprosartan mesylate is rapidly absorbed when administrated orally, with a bioavailability of 13% and a protein binding rate of 98%. The blood peak concentration and AUC (Area Under Curve) can be elevated by about 50% in patients with liver and kidney dysfunction, or fullness after administration, and can be elevated by 2 to 3 folds in elderly patients. Eprosartan mesylate has a structure shown as follows:

 

Figure US20110046391A1-20110224-C00001

 

U.S. Pat. No. 5,185,351 discloses a method for preparing eprosartan mesylate using Eprosartan and methanesulfonic acid in isopropanol (U.S. Pat. No. 5,185,351, Example 41 (ii)). However, it is found when following this method for preparing eprosartan mesylate in industry, an esterification reaction can occur between eprosartan and isopropanol and the following two impurities can be generated:

 

Figure US20110046391A1-20110224-C00002

 

In addition to the above two esterification impurities, the salifying method provided by the above patent is prone to produce isopropyl mesylate. Considering currently known potential risk of gene toxicity of methylsulfonic acid ester on human as well as the stringent requirements of methylsulfonic acid ester from the Europe and the America authorities, it is important to produce eprosartan mesylate in a non-alcohol solvent during the process of producing eprosartan mesylate, since it avoids the formation of methylsulfonic acid ester and the residue thereof in the final product. Since the dosage of eprosartan mesylate is high, it is particularly important to strictly control methylsulfonic acid ester in eprosartan mesylate.

In addition, for the above salifying method, solid eprosartan is suspended in propanol at a low temperature, then methanesulfonic acid is added, about ten seconds later a great deal of eprosartan mesylate precipitate is obtained. Therefore, solid eprosartan may be embedded by the precipitated eprosartan mesylate. Since isopropyl alcohol has a high viscosity at low temperature, a heavy filtering operation burden is needed to obtain solid from isopropanol, and the obtained solid contains quite an amount of isopropanol.

 

 

Eprosartan has been obtained by several different ways: 1) The iodination of 2-butylimidazole (I) with I2 and Na2CO3 in dioxane/water gives 2-butyl-4,5-diiodoimidazole (II), which is treated with benzyl chloromethyl ether (III) and K2CO3 in DMF yielding the imidazole derivative (IV). The condensation of (IV) with N-methyl-N-(2-pyridyl)formamide (V) by means of butyllithium in THF affords 1-(benzyloxymethyl)-2-butyl-4-iodoimidazole-5-carbaldehyde (VI), which is deprotected with concentrated HCl ethanol to give 2-butyl-4-iodoimidazole-5-carbaldehyde (VII). The acylation of (VII) with methyl 4-(bromomethyl)benzoate (VIII) by means of K2CO3 in hot DMF yields 4-(2-butyl-5-formyl-4-iodoimidazol-1 ylmethyl)benzoic acid methyl ester (IX), which is deiodinated by hydrogenation with H2 over Pd/C in methanol affording compound (X). The condensation of (X) with methyl 3-(2-thienyl)propionate (XI) by means of lithium diisopropylamide (LDA) in THF gives (XII), which is acylated with acetic anhydride and dimethylaminopyridine (DMAP) in dichloromethane yielding the corresponding acetate (XIII). Elimination of acetic acid from (XIII) with 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU) in hot toluene affords the expected propenoic ester (XIV), which is finally saponified with NaOH or KOH in ethanol/water.

…………………………………………………………………………………………………….

WO 1998035962 A1

 

 

…………………………………………………………………………………………..

 

 

Eprosartan mesylate.png

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Pfizer 2013 and beyond

 companies  Comments Off on Pfizer 2013 and beyond
Oct 252013
 

Pfizer

Pfizer gets a lot of coverage in the financial papers–even if some of it turns out to be misguided.

For example, Pfizer got the media coverage all drug companies desire on May 4 from Seeking Alpha, http://seekingalpha.com/article/560531-pfizer-alzheimers-drugs-will-carry-stock-to-new-highs-in-2013

a stock market blog that provides free stock market analysis. A piece entitled “Pfizer: Alzheimer’s Drugs Will Carry Stock To New Highs In 2013” had a subheading “strong pipeline.”

Turns out that was too optimistic, as Pfizer’s Alzheimer’s drug–along with Johnson and Johnson’s–both failed to produce. But many stock analysts still hold hope that Pfizer has a new ‘cash cow’ coming down the pipeline.

Daily Finance http://www.dailyfinance.com/2012/09/07/a-peek-at-pfizers-pipeline/

notes that Pfizer currently has 87 drugs in its pipeline. While its true that most are in the early stages, 11 are ready to be reviewed by the FDA.

That number puts it ahead of most of its rivals, with Eli Lilly, a close second, having 63 drugs in Phases 1-3, plus one currently being reviewed. Bristol-Myers Squibb has 46 drugs in development, 7 under review, Merck has 35 drugs in Phase 2 or 3 with two under review, and Johnson and Johnson has 18 drugs that are already in Phase 3 clinical trials or up for FDA approval.

But, of course, as the journal points out, “Quality trumps quantity. . . . One or two blockbusters can be better than several lower-revenue drugs.”

So what does Pfizer have up its sleeve that might begin to fill the very big shoes of Lipitor?

Well, the company has diversified the therapeutic areas under research, with 26% of R&D efforts going toward oncology treatments, 20% to neuroscience and pain, 17% to cardiovascular and metabolic diseases, 14% to inflammation and immunology, 5% to vaccines, and 18% toward ‘other.’

Pfizer has several medicines for diabetes alone coming up, in Phase I and Phase II trials, almost all meant to treat type 2 diabetes.

But, notes Seeking Alpha,http://seekingalpha.com/article/560531-pfizer-alzheimer-s-drugs-will-carry-stock-to-new-highs-in-2013

its blockbuster potential in this area is limited by the existing treatments of Merck and Sanofi. 10% of Sanofi’s total sales come from Lantus,

Lantus

a diabetes drug useful for both types 1 and 2, and Merck made $1.3 billion off its Januvia

januvia

franchise in the first quarter of this year alone.

So hopes are pinned on Pfizer’s tofacitinib, currently under FDA review, as the treatment with the potential to earn $1 billion or more in sales, easing the gaping wound left by Lipitor. Tofacitinib prompts such high hopes because it might possibly treat rheumatoid arthritis, psoriasis, and irritable bowel syndrome. Some analysts have pinned this as the cash cow Pfizer so badly needs to replace treatments lost to the patent cliff.

Tofacitinib

http://seekingalpha.com/article/812981-pfizers-success-with-its-jak-inhibitor

If it gets approved, Tofacitinib would be first treatment for rheumatoid arthritis (RA) in a new class of medicines (known as Jenus kinase, or JAK, inhibitors), and the first JAK inhibitor approved for rheumatoid arthritis.

Tofacitinib showed statistically significant improvement compared to placebo in decreasing the symptoms of RA (as measured by 20% improvement in the American College of Rheumatology scale), in improving physical function (as measured by mean change in Health Assessment Questionnaire-Disability Index), and in leading to remission (as measured by Disease Activity Score 28 ESR).

Joel Kremer, MD, chief of medicine at Albany Medical College in N.Y., after analyzing the data, commented, “Tofacitinib appears to reduce the signs and symptoms of rheumatoid arthritis very quickly. We hope that after carefully considering the benefit/risk equation, this compound will provide an additional valuable treatment option for patients who have experienced inadequate response to prior treatments.”

Pfizer also believes its blood thinner Eliquis, which it is developing with Bristol-Myers Squibb (see below) could be a big money-maker.

apixaban, eliquis

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Alzheimer’s Image Problem Solved

 Uncategorized  Comments Off on Alzheimer’s Image Problem Solved
Oct 252013
 

Copper-based radiopharmaceuticals for diagnostic imaging can target the amyloid-β plaques implicated in Alzheimer’s disease

Read more

http://www.chemistryviews.org/details/news/5384281/Alzheimers_Image_Problem_Solved.html

Alzheimer’s Image Problem Solved

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ViiV Healthcare files new drug application for three-drug HIV pill with US FDA

 NDA  Comments Off on ViiV Healthcare files new drug application for three-drug HIV pill with US FDA
Oct 242013
 

ViiV Healthcare, a joint venture involving GlaxoSmithKline (GSK), Pfizer and Shionogi, has submitted a New Drug Application (NDA) to the US Food and Drug Administration (FDA) for its investigational single-tablet regimen (STR) combining dolutegravir, abacavir and lamivudine for treatment of HIV-1 patients.

click hereViiV Healthcare files new drug application for three-drug HIV pill with US FDA

 

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Ranbaxy obtains approval to market malaria drug in India

 INDIA  Comments Off on Ranbaxy obtains approval to market malaria drug in India
Oct 232013
 

Ranbaxy Laboratories has secured approval from India’s Central Drugs Standard Control Organisation (CDSCO) to produce and market its Synriam drug in the country to treat malaria caused by the Plasmodium vivax parasite in adults.

Ranbaxy obtains approval to market malaria drug in India  CLICK HERE

http://www.pharmaceutical-technology.com/news/newsranbaxy-obtains-approval-market-malaria-drug-india?WT.mc_id=DN_News

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AltheRx obtains US patent for solabegron combination therapy for OAB treatment

 phase 2, Uncategorized  Comments Off on AltheRx obtains US patent for solabegron combination therapy for OAB treatment
Oct 212013
 

solabegron

AltheRx Pharmaceuticals has received a notice of allowance for its patent application from the US Patent and Trademark Office (USPTO) for the use of solabegron, a beta 3-adrenergic receptor agonist, in combination with antimuscarinics at both therapeutic and sub-therapeutic doses, for the treatment of overactive bladder (OAB).

AltheRx obtains US patent for solabegron combination therapy for OAB treatment

http://www.pharmaceutical-technology.com/news/newsaltherx-obtains-us-patent-for-solabegron-combination-therapy-for-oab-treatment?WT.mc_id=DN_News

 

Solabegron (GW-427,353) is a drug which acts as a selective agonist for the β3 adrenergic receptor. It is being developed for the treatment of overactive bladder andirritable bowel syndrome.[1][2][3] It has been shown to produce visceral analgesia by releasing somatostatin from adipocytes.,[4][5]

Solabegron was discovered by GlaxoSmithKline and acquired by AltheRx in March 2011. Solabegron relaxes the bladder smooth muscle by stimulating beta-3 adrenoceptors, a novel mechanism compared to older established drug treatments for overactive bladder syndrome such as the anticholinergic agents. Astellas Pharma have developed the first commercially available β3 adrenergic receptor, mirabegron, which is now licensed in Japan[6] and the US[7] for overactive bladder. Mirabegron is not licensed for irritable bowel syndrome.

A Phase II study of Solabegron for overactive bladder (OAB) looked at 258 patients with moderate to severe incontinence experiencing an average of 4.5 wet episodes per day. Results demonstrated a statistically significant improvement with Solabegron as compared to placebo, as measured by the percent reduction of the number of wet episodes and the absolute number of daily voids.

A Phase II study for irritable bowel syndrome (IBS) evaluated 102 patients with IBS. Solabegron demonstrated significant reduction in pain associated with the disorder and a trend for greater improvement in the quality of life, compared to placebo.

Both Phase II studies indicated a tolerability profile for Solabegron that was similar to placebo. The OAB patients did not suffer from dry mouth, constipation, increase in heart rate or cognitive issues.

AltheRx is currently preparing to advance Solabegron into a large clinical study in OAB.

Synthesis

Solabegron scheme.png

  1.  Hicks A, McCafferty GP, Riedel E, Aiyar N, Pullen M, Evans C, Luce TD, Coatney RW, Rivera GC, Westfall TD, Hieble JP. GW427353 (solabegron), a novel, selective beta3-adrenergic receptor agonist, evokes bladder relaxation and increases micturition reflex threshold in the dog. Journal of Pharmacology and Experimental Therapeutics. 2007 Oct;323(1):202-9.doi:10.1124/jpet.107.125757 PMID 17626794
  2.  Grudell AB, Camilleri M, Jensen KL, Foxx-Orenstein AE, Burton DD, Ryks MD, Baxter KL, Cox DS, Dukes GE, Kelleher DL, Zinsmeister AR. Dose-response effect of a beta3-adrenergic receptor agonist, solabegron, on gastrointestinal transit, bowel function, and somatostatin levels in health.American Journal of Physiology. Gastrointestinal and Liver Physiology. 2008 May;294(5):G1114-9. PMID 18372395
  3.  Kelleher DL, Hicks KJ, Cox DS, et al. Randomized, double-blind, placebo (PLA)-controlled, crossover study to evaluate efficacy and safety of the beta 3-adrenergic receptor agonist solabegron (SOL) in patients with irritable bowel syndrome (IBS). Neurogastroenterol Motil 2008;20 (Suppl 2):131.
  4.  Cellek S, Thangiah R, Bassil AK, Campbell CA, Gray KM, Stretton JL, Lalude O, Vivekanandan S, Wheeldon A, Winchester WJ, Sanger GJ, Schemann M, Lee K. Demonstration of functional neuronal beta3-adrenoceptors within the enteric nervous system. Gastroenterology. 2007 Jul;133(1):175-83.
  5. Schemann M, Hafsi N, Michel K, Kober OI, Wollmann J, Li Q, Zeller F, Langer R, Lee K, Cellek S. The beta3-adrenoceptor agonist GW427353 (solabegron) decreases excitability of human enteric neurons via release of somatostatin.Gastroenterology 2009 Sep 25. [Epub ahead of print]
  6.  http://www.ncbi.nlm.nih.gov/pubmed/22384458
  7.  http://chembl.blogspot.co.uk/2012/07/new-drug-approvals-2012-pt-xiv.html
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MONOCLONAL ANTIBODIES

 MONOCLONAL ANTIBODIES  Comments Off on MONOCLONAL ANTIBODIES
Oct 172013
 

PPT from many87

Production of MAb

Fig.1 Production of MAb

Large Scale Production Of MAbs:

Commercially, on large scale, MAbs are produced by two methods.

(a) Ascites production in mice

(b) In-vitro fermentation

The production method is summarized in Fig.no.2a & 2b.

a) Ascites Production In Mice:

The first monoclonal antibodies approved by FDA for therapeutic use OKTS, is produced by ascitic technology19.

In this method hybridoma cells are injected into peritoneal cavity of histocompatible mice. The mice are pretreated by i.p. injection of Pristane to irritate the peritoneal cavity which facilitates the growth of ascitic tumor. The fluid produced may contain the high concentration of secreted MAbs, 2 to 20 μg / ml and 2 to 6 ml or more can be harvested per mouse. Comparison of different MAb production22,23 methods is shown inTable 1.

Drawbacks of this method are:

1. It is very costly, very difficult and not reliable.

2. Product may get contaminated with mouse immunoglobulins and also with other mouse proteins.

3. Viruses can be introduced as contaminants.

4. Antibody yield is often less as compared to other methods.

b) In-Vitro Fermentation:

In this method, the cells are grown and gradually moved to larger and larger culture ensuring exponential growth. Typical antibody levels in the culture supernatant ranges from 5-50 μg/ml depending on the individual clone and on cell density. When more production of antibody is required 1-litre cultures in roller bottles are used. Required cells are removed from rest of media by centrifugation or filtration, generally followed by ultra filtration step for concentrating the filtrate by up to 20 folds.

Advantages of this method are:

(1) As serum required in culture media is reduced, it is cost effective.

(2) There will not be any contamination with mouse immunoglobulin.

But the major drawback is that of contamination of final product with serum or protein based growth factors.

Table 1: Comparison of different MAb production methods.

Production system

Scale

Volume (ml)

Concentration (mg/ml)

Production time (weeks)

Quality

Ascites (in vivo)

20-250 mg

5-10

< 20

2-3

Low
Stir growth

100-2500

0.01-0.1

2-3

High
Dialysis membrane

< 50 mg

10-25

0.1-1.5

2-5

High
Roller bottles

< 2 gm

100-2000

0.01-0.2

2-6

High
Hollow fiber

0.15-30 gm

25-1000

0.2-0.3

3-12

High
Fermentor

2-100 gm

< 2000 lit

0.05-0.5

2-12

High

 MAb Production

Fig. 2a:  MAb Production (Flowchart)

 Freeze Dried MAb Production

Fig. 2b:  Freeze Dried MAb Production (Flowchart)

i) Purification:

Contamination, during production process, such as protein, nucleic acid, endotoxins, immunoglobulin and adventitious agent can be removed by purification method. The purification methods such as precipitation with ammonium sulphate, zone electrophoresis, ion exchange chromatography, hydrophobic interaction chromatography, gel filtration and affinity chromatography are used19.

· Affinity chromatography is often used for initial purification.

· Ion exchange chromatography is used for removing endotoxins and DNA.

· Gel filtration chromatography can remove both high and low molecular form of monoclonal antibodies and it is usually used as the final polishing step.

j) Characterization:

The final determination of monoclonality requires biochemical and biophysical characterization of the immunoglobulin. It is also characterized immunochemically to define its affinity for antigen, its immunoglobulin subclass, the epitopes for which it is specific and the effective number of binding site that it possesses19.

k) Final Processing:

Depending upon the intended application, the antibody may be conjugated to specific radionuclide or toxin. Then the stabilizing agent is added, and the product is filled into final container under inert gas or other specialized conditions.  Lyophillization is frequently applied to get freeze dried product.

Antigenicity Of Murine MAb:

The main problem for mouse MAb is that, human body recognizes it as a foreign agent and produces antibodies against such mouse MAb. The induced human anti-mouse antibodies (HAMA) quickly reduce the effectiveness of mouse MAb and also their interaction may lead to allergic reactions.

To overcome the problem, Human MAbs can be used. Though difficult, this is possible by fusion of EBV (Epstein Barr Virus) transformed human B-lymphocyte with appropriate fusion partners21. EBV is a lymphotrophic DNA herpes virus which is capable of converting normal B-lymphocytes of human and/or mouse into cancer cell having proliferating capacity in vitro. But the presence of EBV as contaminant can pose a problem of producing cancer24.

Even the human-human hybridomas producing MAbs have been produced 25,26. Olsson and Kaplan in the year 1980 produced first human-human myeloma (SKO-007), against the hapten 2, 4-dinitrophenyl (DNP) 19.

The routine production of human MAbs is prevented due to following reason:-

  • Sources of antibody producing cells27.
  • Reliable methods for lymphocytes immortalization.
  • Stability28 and antibody producing capacity.
  • Administration of some antigens to humans could endanger their health29.
  • Recovery of B-lymphocytes from the spleen of human is impracticable.
  • The fusion of human lymphocytes with human lymphoblastoid cell lines is a very inefficient process.
  • Low production yield of human monoclonal antibody.

Hence, other alternatives methods come forth.

Advantages Of MAbs:

  • Pure one molecular species with high specificity for a particular antigenic target.
  • Anti-serum titer values are high.
  • Antibodies with high avaidity can be produced.
  • In vitro and in vivo production is possible.
  • Radiolabelling and fluorescent conjugation of monoclonal antibody are easy.

Disadvantages Of MAbs:

  • Initial cost involved in the technique is high. However, continuous production is somewhat economical.
  • Methods are time consuming.
  • Antigenicity of Murine MAb.
  • MAbs have comparatively less complement fixing ability than that of convectional antiserum.
  • MAbs are highly selective for a particular single antigenic determinant. This renders them incapable of distinguish between different molecules, cells bearing the chemical structure or determinants except one against which it is targeted.
  • The high antibody avidity (energy of binding to an antigen) of MAbs is advantageous for immunoassay but some property is undesirable for purification process.
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Formulation Development of Insoluble Drugs

 drugs, GENERIC, MANUFACTURING, nanotechnology  Comments Off on Formulation Development of Insoluble Drugs
Oct 152013
 

Formulation development of insoluble drugs has always been a challenge in pharmaceutical development. This presentation reviews some current options to old problem.

PharmaDirections, Inc.

by , Working at PharmaDirections, Inc

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MannKind Resubmits New Drug Application to U.S. FDA for AFREZZA for the Treatment of Adults with Diabetes

 NDA  Comments Off on MannKind Resubmits New Drug Application to U.S. FDA for AFREZZA for the Treatment of Adults with Diabetes
Oct 152013
 

VALENCIA, Calif., October 14, 2013 –(BUSINESS WIRE)–MannKind Corporation (Nasdaq: MNKD) today announced the resubmission on October 13, 2013 of a new drug application (NDA) to the U.S. Food and Drug Administration (FDA) seeking approval for the marketing and sale of AFREZZA® (insulin human [rDNA origin]) Inhalation Powder with an indication to improve glycemic control in adults with type 1 or type 2 diabetes. The resubmission is based on the entire data set from the extensive AFREZZA clinical development program and particularly the positive results from two recent Phase 3 trials, one in patients with type 1 diabetes (study 171) and one in patients with type 2 diabetes (study 175).

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