Intranasal epinephrine provides faster absorption than autoinjector for anaphylaxis

14th August 2023

An intranasal epinephrine formulation leads to faster absorption of the drug than from an Epipen autoinjector, providing a clinical advantage in the short therapeutic window for the treatment of anaphylaxis, the manufacturer Nasus Pharma has announced.

Positive results from a clinical study of the investigational powder-based epinephrine, FMXIN002, were published in the Journal of Allergy and Clinical Immunology in Practice. The study was designed to compare intranasal epinephrine pharmacokinetics, pharmacodynamics, and safety compared to an autoinjector.

The open-label trial was undertaken in 12 adults with seasonal allergic rhinitis but without asthma. The participants received three-sequenced treatment with either 0.3 mg intramuscular (IM) epinephrine via an autoinjector or intranasal epinephrine in dosages of 1.6 mg and 3.2 mg. Each intranasal dosage was tested under normal conditions and under nasal allergen challenge in which nasal congestion was created to simulate the congestion of the nose in anaphylaxis.

Intranasal epinephrine versus autoinjector

The results demonstrate that the exposure (area under the curve, AUC_0-t) and maximum plasma level (C_max) of a 3.2 mg dose of epinephrine was comparable to a 0.3 mg IM injection of epinephrine under normal nasal conditions.

Moreover, FMXIN002 showed a significantly superior pharmacokinetic profile, especially during the first 30 minutes under induced nasal congestions that occur in severe allergic reactions. In fact, C_max was double compared to IM autoinjector (1110 vs. 551) and the AUC _{(0-8h )} was 56% higher.

In addition, the time to maximum plasma level (T_max) and time to 100 pg/mL of a 3.2 mg FMXIM001 dose was significantly faster at 2.5 minutes compared to nine minutes for the autoinjector. The median time to 100 pg/mL was 3.0 minutes under normal conditions and 1.0 minutes under allergenic challenge that represents the real-life conditions of the nose in severe allergic reaction for FMXIN002. This time to 100 pg/mL is considered to be the clinical threshold where pharmacodynamic responses begins to occur.

The treatment was well tolerated and there were no significant side effects and no significant changes physiological parameters.

Taken together, these findings indicate that FMXIN002 can provide an unprecedented quick rescue with a non-invasive easy to use device for life threatening allergic reactions.

Dr Dalia Megiddo, CEO of Nasus Pharma, said: ‘The results of Nasus’s FMXIN002 powder intranasal epinephrine study show that it can provide a safer and more effective rescue for the emergency treatment of life-threatening allergic reactions by providing a compact easy-to-use device and quicker absorption of Epinephrine.‘

Professor Yuval Tal, director of the Allergy and Clinical Immunology Unit at Hadassah Medical Center in Jerusalem and head of the study, added: ‘In cases of severe life-threatening allergic reaction the therapeutic time window is very short and immediate rescue with epinephrine is required. Therefore, the pharmacokinetics/pharmacodynamics of epinephrine rescue are extremely important.

‘Failure to administer epinephrine promptly has been identified as the most important factor contributing to death from anaphylaxis. Parents and caregivers are often hesitant to give injections. Teenagers are averse to carry the bulky two injection package with them at all times and are sadly over-represented in fatality cases.

‘A pocket-size, user-friendly nasal inhaler could make the much-needed difference sorely needed for rescue therapy of life-threatening allergic reactions. This, in addition to the significantly shorter time to therapeutic blood levels and higher drug exposure in the critical first half an hour, indicate that FMXIN002 could change dramatically the fatality risk associated with anaphylaxis.‘

Intranasal epinephrine provides comparable outcomes to IM auto-injector

3rd March 2023

An intranasal epinephrine device provides comparable pharmacokinetic and pharmacodynamic outcomes to an auto-injector device

An intranasal epinephrine device provides comparable pharmacokinetic and pharmacodynamic outcomes to those of an auto-injector and manual syringe, according to the findings of a study presented at the American Academy of Allergy Asthma and Immunology (AAAAI) in San Antonio, US and which was published as a supplement to the Journal of Allergy and Clinical immunology.

Anaphylaxis is a serious allergic reaction which has a rapid onset and can lead to death, thereby warranting the need for emergency preparedness with epinephrine (adrenaline) autoinjectors, together with knowledge of how these devices should be used. However, some evidence suggests significant differences in patients’ carrying time, confidence in use and training experiences with auto-injectors, particularly EpiPens. The use of an intranasal device has already been explored as an anaphylactic treatment and found to have significant absorption via the this route. Moreover, evidence from 4 studies including 175 patients, also showed that intranasal epinephrine increased systolic blood pressure more efficiently than both manual and auto-injectors, despite achieving lower maximum plasma concentrations.

In the data presented at AAAAI, researchers undertook an open-label, 3-period, cross-over study, in 100 healthy adults to assess the relative bioavailability of a single intranasal dose of epinephrine, 13.2mg and which consisted of two consecutive sprays as opposite and single nostril dosing. These were then compared to an intramuscular 0.3 mg auto-injector and a 0.5 mg manual syringe.

Intranasal epinephrine outcomes

The pharmacokinetic parameters for the 13.2 mg intranasal device was higher than that from the 0.3 mg auto-injector (C_max, intranasal = 429.4, auto-injector = 328.6). However, the peak epinephrine concentrations were similar for the auto-injector (14 minutes) and the intranasal device (20 minutes) when compared to the manual syringe (45 minutes).

There were also similar pharmacodynamic effects based on changes in systolic blood pressure and heart rate between the auto-injector and intranasal device as well as no safety differences.

The authors concluded that the intranasal form offers a needle-free, convenient and effective dose delivery system for self-administration of epinephrine and which could serve as an alternative to an intramuscular auto-injector for acute anaphylaxis management.

Citation
Dworaczyk D, Hunt A. 13.2mg Intranasal Epinephrine Spray Demonstrates Comparable PK/PD and Safety to 0.3mg Epinephrine Autoinjector. J Clin Allergy Immunol 2023

The poster presentation can be found here.