Biotech Stock Mailbag Extra: MannKind's Afrezza Panel Setup

 "TormenM" emails a question about MannKind (MNKD) and its inhaled insulin device Afrezza:

Thanks for the March calendar of biotech events. How do you see MannKind setting up for the FDA panel on Afrezza?


Last fall, MannKind CEO Al Mann and CFO Matt Pfeffer were telling investors an FDA advisory panel for Afrezza was "extraordinarily unlikely" based on feedback from the agency's review staff. Today, we're 26 days away from an Afrezza FDA panel. Interesting reversal.

Maybe MannKind totally mis-read the situation and FDA always intended to convene a panel for Afrezza. Or, maybe some time between last fall and January, MannKind received feedback from the FDA suggesting the agency had serious problems with the new Afrezza phase III data. MannKind, desperate to rescue Afrezza from a third rejection, then asked FDA to schedule a panel -- something drug sponsors are allowed to do.

Either way, I think you should expect the FDA panel for Afrezza to be volatile. These gatherings are rarely coronations and the data from the Afrezza phase III studies (as described to us by MannKind in press releases only) are pretty hairy.

One of my 2014 biotech stock predictions was an FDA rejection of Afrezza.

I elaborated on my reasons in January

The results from the two phase III studies announced this summer were barely passable. In Type 1 diabetics, Afrezza was numerically worse than Novo Nordisk's (NVO) Novolog. The study met its primary endpoint -- barely -- only because MannKind set a low bar with respect to the statistical non-inferiority endpoint.

Results from the study in Type 2 diabetics were more favorable for Afrezza but still, the product under-performed relative to MannKind's expectations. Afrezza also caused more weight gain in Type 2s.

We still don't know, exactly, how the current "Dreamboat" inhaler performed relative to the older Medtone inhaler. And MannKind has been flinty with Afrezza safety data. We know the inhaled insulin causes a persistent cough. MannKind claims the cough is benign, but what will FDA say?

I don't have much to add except to remind everyone that I will live blog the Afrezza FDA panel on April 1. Also, don't forget FDA will post briefing documents -- including the agency's Afrezza medical review -- on March 28.

l'll end with a chart of MannKind's stock performance since the August release of the Afrezza phase III data relative to the biotech sector. Bearish.

MNKD Chart
MNKD data by YCharts
Adam Feuerstein writes regularly for TheStreet. In keeping with company editorial policy, he doesn't own or short individual stocks, although he owns stock in TheStreet. He also doesn't invest in hedge funds or other private investment partnerships. Feuerstein appreciates your feedback; click here to send him an email.

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