New Neffy nasal spray alternative to EpiPen could be a ‘game changer’ for people with allergies

Millions of Americans who have allergies have really only had one option when it comes to emergency treatment for a severe reaction: using an auto-injector like the EpiPen.

But now there is an alternative. The US Food and Drug Administration recently approved a new nasal spray that delivers epinephrine, the drug used to stop reactions, into the nose instead of being injected with a needle.

The spray, sold under the brand name neffy, will address some of the main concerns people have with the EpiPen, which include cost, delivery method and size, North East experts say.

“There is a significant percentage of the population that has some form of allergy,” says Neil Maniar, director of the master’s of public health program and professor of practice at Northeastern University. “Until now, when it comes to giving a quick shot of epinephrine, the EpiPen has been the only option.

“Over the past few years, the cost of the EpiPen has gone up. It’s also an injection… Some people have very strong feelings and fears about it… (The nasal spray) is a game changer. It’s a really important step from the public. health perspective to have that alternative that hopefully can be more readily available and used more easily.”

The cost of EpiPens skyrocketed around 2016, when Mylan acquired the product, says Gary Young, professor of public health and director of Northeastern University’s Center for Health Policy and Health Research. EpiPens cost about $100 per two-injector pack; now it costs about $600. Mylan licensed a generic product at half the cost, but the price still made the device unaffordable for many.

“There didn’t seem to be any justification other than Mylan had acquired the product and felt they could set it at that level and generate the margins they wanted to generate,” says Young. “It looked pretty painful and they got a lot of flak for it.”

Neffy is expected to cost $199 for two doses for people without insurance. Patients with commercial insurance can get two doses for $25. That price means Mylan has a reason to become more competitive with their products, Young says.

“It will probably have a very big impact because I think people will prefer the spray to the needle,” he adds. “I think it will also have a big impact on EpiPen pricing. … Over time, this will be a very significant competitive threat to the pen, and I expect to see prices come down.”

Even those with an epinephrine injection don’t always use it in an emergency. ARS Pharma, the maker of Neffy, says it found that more than half of those with a pen did not use it in an emergency.

Mansoor Amiji, a distinguished professor of pharmaceutical sciences and chemical engineering at Northeastern, says the nasal spray has been shown to be just as effective as the injectable, but it doesn’t involve a needle. Not only can this ease the fears people may have around needles, but it’s also easier to use and lowers the risk of infection.

In the event of an anaphylactic reaction, a person needs epinephrine immediately, so there may not always be time to clean the insertion site, presenting a risk of contamination, Amiji explains.

“The risk is relatively minor compared to the benefit,” he says. “(But) individuals, especially children, who don’t like needles find this an alternative. It is a much safer way of administration and much more compliant with patients”.

Amiji adds that the new nasal spray is also much smaller than the injectables, which are about 6 inches long.

“One of my friends used to call it (the EpiPen) the baton,” he says. “The fact that (the spray) is small enough to fit in a purse or pocket (makes it) much easier to carry around.”

Maniar says that because of these concerns, many people with allergies don’t carry an EpiPen or a generic injectable. According to ARS Pharma, the maker of the nasal spray, only 3.2 million of the 40 million people in the United States at risk of severe allergic reactions had a prescription for an epinephrine pen. Another recent study found that only about half of adults with food allergies had access to epinephrine.

Having a new option could address some of these people’s concerns and increase the rate of people carrying EpiPens and, subsequently, the number of hospitalizations and deaths from allergic reactions, Maniar says.

“A lot of this is going to be around health communication and really letting people know and letting families know that this is available, that it’s safe, that it’s effective,” he adds. “Giving people the information they need to make the right decisions about their health, I think it will (have an impact).”

This story is republished courtesy of Northeastern Global News news.northeastern.edu.