The U.S. Food and Drug Administration (FDA) has shocked many by deciding not to approve a pioneering nasal spray as an alternative to current epinephrine autoinjectors, like EpiPens. The announcement was met with surprise, especially from ARS Pharma, the creator of the product named Neffy. The FDA’s move came despite an earlier endorsement in May 2023 from an independent FDA Advisory Committee.
Request for More Studies
In its communication, the FDA pinpointed the need for further studies, specifically on the impact of multiple doses of neffy in comparison with repeat epinephrine injections. This took the company off-guard, as ARS Pharma mentioned they had previous alignments with the FDA for post-market studies on this issue. Now, the demand for these studies before the product’s approval adds an unexpected obstacle to its market debut.
Richard Lowenthal, ARS Pharma’s co-founder and CEO, expressed his astonishment at the decision, noting that numerous committee members had previously spotlighted Neffy’s promising profile. He also mentioned the firm’s intention to both appeal the FDA’s decision and expedite the required trials.
Furthermore, the disappointment echoed in the words of Dr. Sung Poblete, CEO of the nonprofit group Food Allergy Research and Education (FARE). Poblete stressed the potential value of neffy for the vast community of Americans with severe food allergies and expressed frustration at the delayed introduction of this innovative treatment.
Understanding Neffy’s Mechanism
Efficiency and Ease of Use
• Neffy operates similarly to Narcan, a nasal spray that counters opioid overdoses.
• The user simply places the device in a person’s nostril and presses, releasing the medication.
• The spray gets absorbed automatically by the nasal mucosa, eliminating the need for the patient to breathe in or snort.
• A unique solvent ensures effective absorption of epinephrine in the nose.
• FARE endorsed the spray for both adults and children over six years of age.
Comparing with Injectable Epinephrine
Notably, the data provided to the FDA indicates that Neffy’s performance is on par with injected epinephrine, as conveyed by Dr. Corinna Bowser, an independent allergist. Typically, the results of injected epinephrine can vary based on an individual’s age, weight, and body mass, but neffy is purported to display more consistent results.
Reported Side Effects
Those who tested the product mostly reported mild side effects, which included:
• Nasal discomfort
• Runny nose
• Moderate dizziness and vomiting
• Mild throat irritation
The Current Reality and What Awaits
Many believe that neffy could be a game-changer in treating severe allergic reactions. A survey from 2021 highlighted the underuse of epinephrine autoinjectors, especially among young patients. The reasons ranged from underestimating the severity of allergic reactions to fear of utilizing autoinjectors.
Christine Creter, a mother to a 12-year-old with multiple food allergies, emphasizes the potential ease of administering a nasal spray in contrast to injections. Given the user-friendly nature of the nasal spray, experts foresee its broad utility in various settings, including schools, airplanes, and first-aid kits. The fact that it requires no formal training for administration makes it even more attractive.
Implications for the Medical Community
Alternative to Autoinjectors
The successful introduction of neffy would significantly alter the landscape of anaphylaxis treatment. Autoinjectors, though effective, have their set of challenges. Many patients, especially children, exhibit a phobia of needles. This leads to a delay in administration or, in worst-case scenarios, avoidance of the life-saving medication entirely. Neffy, with its non-invasive approach, can address this gap effectively.
Potential Economic Impact
The introduction of a new product in the medical field often affects the economic dynamics of the sector. If Neffy secures FDA approval and becomes widely accepted:
• There could be a decrease in the sales of traditional epinephrine autoinjectors.
• Manufacturers of autoinjectors might explore innovations or partnerships to adapt to the changing market demand.
• The pricing strategy of neffy will play a crucial role in determining its adoption rate. If priced competitively, it might achieve rapid market penetration.
If approved, neffy will mark the debut of a needle-free nasal spray epinephrine treatment for those with severe allergies. There is an evident need for such a product, considering about 40 million Americans suffer from acute allergic reactions. The often intimidating nature of needles can lead to hesitation in administering crucial, timely care. ARS Pharma has projected the resubmission of the necessary data to the FDA in the first half of 2024. If all goes well, the company anticipates receiving FDA approval by the latter half of the same year, paving the way for a revolutionary treatment method for those suffering from severe allergic reactions.