INSM is probably going to get Arikace (inhalational amikacin) added to the relatively short list of inhalational antibiotics sometime in the next 12 months. As an investor in INSM, I watched the company flounder under really poor management and then they got an aggressive, intelligent new CEO. Will Lewis turned that company around after several major problems with one preclinical study and a poor understanding of the science they had. Now they are going to get their product approved as an new addition to the treatments for Pseudomonas aeruginosa for CF patients and (probably) the only bona fide treatment for NTM. But their main advantage is the liposome which allows the antibiotic to be inhaled once per day and last all day. That is a huge advantage. Pulmoquin is a once per day because of the same composition. A liposome carries the antibiotic into the lung and causes two things to happen:
1. The liposome dissolves the biofilm that surrounds and protects the bacteria from being reached by blood borne antibiotics; and
2. The liposome is taken up by the fixed macorphages in the lungs which are the cells that removed debris from the lungs and start an immune response against foreign bodies like bacteria.
So Pulmoquin, like Arikace, has less consequences if the patient misses a dose and accumulates in the places where the bacteria are protected anyway. The drug is a pretty well thought out molecule.