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March 04, 2024
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Most physicians agree that needle-free epinephrine would improve use

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Key takeaways:

  • Overall, 86% of physicians felt that patients would prefer needle-free epinephrine.
  • Patient confidence in dosing could lead to better outcomes and quality of life, a researcher said.
Perspective from Robert W. Hostoffer, DO

WASHINGTON — Most physicians believed that needle-free epinephrine delivery would be preferable among patients, and that it would lead to more patients carrying it and using it faster, survey results showed.

According to Ayman Kafal, PhD, vice president of medical affairs at ARS Pharmaceuticals, previous surveys of patients suggest that many are hesitant to carry, fill or administer epinephrine autoinjectors.

PC0224Kafal_AAAAI_Graphic_01_WEB
Data derived from: Kafal A, et al. Abstract 229. Presented at: AAAAI Annual Meeting; Feb. 23-26, 2024; Washington, D.C.

“The purpose of this study was to understand whether physicians were aware of these issues, and whether a new alternative epinephrine nasal spray could help to address these issues faced by patients,” he told Healio.

Kafal and colleagues conducted a 30-minute, double-blinded survey with allergists (n = 150), pediatricians (n = 90) and primary care providers (n = 75) in September 2022. They presented their findings at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

When physicians were asked about their patients’ and caregivers’ perceptions about current treatment:

  • 66% agreed that patients and caregivers do not recognize the importance of carrying a needle-injector as directed;
  • 61% agreed that patients and caregivers avoided a needle-injector because they were afraid of needles; and
  • 55% agreed that patients and caregivers avoided using a needle-injector because it is painful.

When physicians were asked about a needle-free means of delivering epinephrine:

  • 86% agreed that patients would prefer it;
  • 79% agreed that it would lead to more people carrying it;
  • 90% agreed that patients and caregivers will be more likely to use it; and
  • 86% agreed patients and caregivers would likely use it faster.

Additionally, 62% of physicians said they would prescribe needle-free epinephrine for 50% or more of their patients.

In May 2024, an FDA committee recommended approving a low-dose intranasal epinephrine spray — or neffy spray — that was developed by ARS Pharma as an alternative to needle-injectors. But in September of last year, the FDA asked the company to conduct an additional study with repeat doses under allergen-induced allergic rhinitis conditions. That research is underway.

“Once an epinephrine nasal spray is approved by the FDA, physicians believe that a nasal spray can address the issues encountered with epinephrine autoinjectors with respect to carriage, use and prompt use,” Kafal said. “Furthermore, by allowing patients to dose confidently without anxiety or hesitation at the first sign of an allergic reaction, this may lead to better clinical outcomes and quality of life vs. delayed treatment.”

For future research, Kafal suggested comparing the results of the survey of providers with one taken by patients and parents or caregivers, which “could reveal disparities between the perceptions of health care providers and those of the individuals directly impacted by severe allergic risks.”

“By understanding both sides of the equation, physicians can tailor their communication and educational efforts more effectively, addressing the specific concerns and preferences of patients and parents,” he said. “This collaborative approach, or shared decision making, may contribute to improved patient education, enhanced adherence, and ultimately better management of severe allergic reactions.”