Discussing FDA approved neffy with Russell Libby, MD, FAAP

A new needle-free epinephrine delivery method may transform the management of anaphylaxis in pediatric patients. Russell Libby, MD, FAAP, founder and president of Virginia Pediatric Group, expressed enthusiasm about epinephrine nasal spray (neffy; ARS Pharmaceuticals), approved by the FDA for type I allergic reactions, including anaphylaxis on August 9, 2024.

“I think this is really cool. I think it's going to really just float way to the top as soon as it becomes an option and people are aware of it. And I'll tell you, there are a number of reasons,” said Libby. "One of the most significant advantages is that the spray it's a needle-free, stable solution.”

“When you look at EpiPens, you have a real narrow window of temperatures where it stays stable. What does that mean? Well, sometimes it can become impotent, but more often, the potency just diminishes. So you might get 90% or 70%, whatever it is. I don't think we have a lot of data on it, but we know that it is very specific to be stored within basically room temperature 60 to 90 degrees,” Libby explained. In contrast, neffy remains stable even in extreme conditions, providing a more reliable option for patients.

Shelf life also presents a key benefit. Libby highlighted that “no drug I can imagine on the market that is prescribed more often and used less than EpiPen.” With auto-injectors typically expiring within 12 to 15 months, parents frequently seek refills.

“Now you have something that gives you a 2-plus-year duration that's pretty impressive, that, in and of itself, is reason enough to say, 'hey, we have an alternative,'” Libby said.

The nasal spray design also simplifies administration, an important factor during emergency situations. “When we think of a nasal administration, we think, 'Oh, you have to sniff it.' No, you don't. You just deploy it. It'll spray in, and that's all that needs to be done,” Libby explained.

Libby hopes the new option will be affordable and widely available.

“I hope that it ends up on the formularies with that $25 copay, and that patients can have this as an option to carry as well as to store in places where they might end up needing that,” he said.

Reference

1. Fitch, J. Epinephrine nasal spray now available to treat type I allergic reactions, anaphylaxis. Contemporary Pediatrics. September 24, 2024. Accessed December 24, 2024. https://www.contemporarypediatrics.com/view/epinephrine-nasal-spray-now-available-to-treat-type-i-allergic-reactions-anaphylaxis