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AIR Inhaled Insulin in Subjects With Chronic Obstructive Pulmonary Disease

Pharmacokinetics, glucodynamics, safety, and tolerability

¹ Profil Institute for Metabolic Research für Stoffwechselforschung, Neuss, Germany
² Eli Lilly, Indianapolis, Indiana
³ Eli Lilly Services, Mont-Saint-Guibert, Belgium
⁴ Alkermes, Cambridge, Massachusetts

Address correspondence and reprint requests to Dr. Klaus Rave, Profil Institut für Stoffwechselforschung GmbH, Hellersbergstr. 9, 41460 Neuss, Germany. Email: klaus.rave{at}profil-research.de

OBJECTIVE— In this open-label, randomized, crossover study, pharmacokinetic and glucodynamic responses were compared in healthy subjects versus subjects with moderate chronic obstructive pulmonary disease (COPD), following administration of 12 units equivalent AIR inhaled insulin versus 12 units subcutaneous insulin lispro.

RESEARCH DESIGN AND METHODS— Three nonsmoking groups (n = 15 each)— healthy subjects (baseline mean ± SD age 38 ± 13 years, forced expiratory volume in 1 s [FEV₁] 4.06 ± 1.04 l), subjects with chronic bronchitis (aged 53 ± 9 years, FEV₁ 2.14 ± 0.60 l), and subjects with pulmonary emphysema (aged 58 ± 6 years, FEV₁ 1.67 ± 0.61 l)— were randomly assigned to one of three treatment sequences. Three euglycemic glucose clamp procedures were performed.

RESULTS— In subjects with chronic bronchitis and emphysema, AIR inhaled insulin administration resulted in reduced insulin exposure (area under the serum insulin concentration curve from time zero until time of return to baseline [AUC_0–t']) (55.7%, P = 0.13 and 78.5%, P < 0.001, respectively) and reduced total insulin effect (total glucose infusion rate) (60.4%, P < 0.01 and 67.1%, P < 0.01, respectively) relative to healthy subjects. Subcutaneous insulin lispro administration resulted in similar responses across study groups for insulin exposure and metabolic effect. Intrasubject pharmacokinetic and glucodynamic variability ranged from 17 to 52% across groups. No significant differences were shown for pre- and postclamp pulmonary function tests. During clamps, FEV₁ and forced vital capacity declined modestly in both COPD groups, with no difference between AIR insulin and subcutaneous insulin lispro.

CONCLUSIONS— Short-term exposure to AIR inhaled insulin was well tolerated by COPD subjects, showing similar time-exposure and time-action profiles, but with reduced insulin absorption and metabolic effect compared with healthy subjects. Further clinical evaluation is warranted in patients with comorbid diabetes and COPD.

Abbreviations: AUC_0–t', area under the serum insulin concentration curve from time zero until time of return to baseline • C_max, maximum immunoreactive insulin concentration • COPD, chronic obstructive pulmonary disease • DL_CO, carbon monoxide diffusing capacity • FEV₁, forced expiratory volume in 1 s • FVC, forced vital capacity • GIR, glucose infusion rate • IRI, immunoreactive insulin • PFT, pulmonary function test • TLC, total lung capacity

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