Thomas B. Casale, MD: Discussing New Findings on Neffy for Urticaria Flares

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In an interview during the 2024 AAAAI conference, Casale addressed his team’s findings regarding epinephrine nasal spray and its effectiveness with regard to exacerbations of urticaria.

Low-dose intranasal epinephrine spray ARS-2, also known as ‘neffy,’ is under development as a potentially needle-free treatment option for severe allergic reactions such as anaphylaxis, as well as treatment of urticaria exacerbations.

A recent phase 2 study evaluated neffy’s efficacy in patients experiencing urticaria flares, indicating potential and implications for treatment. In a new interview with study author Thomas B. Casale, MD, professor of medicine and pediatrics and chief of clinical and translational research for the University of South Florida, spoke with the HCPLive editorial team on these findings.

“Well, the one thing about (neffy), or intranasal epinephrine, is that it's a new approach to giving epinephrine, which in the past has always been by injection,” Casale explained. “And we typically prescribe injectable epinephrine for people to use if they have an acute allergic reaction, from food from a stinging insect. Primarily those types of things.”

Casale noted, however, that the question posed among clinicians from this recent product has been whether or not the treatment would work among those with urticaria, given that when epinephrine is typically given to those with flares it tends to work.

“So in this study, patients were given intranasal epinephrine or placebo and sort of a crossover,” Casale said. “So they got 2 different doses of neffy, the ARS product, or placebo. In 1 period, they might get 2 milligrams, next period 1, next period placebo, whatever. And the patients with the hives then were evaluated for the response…What they found is that, yes, the hives go away very rapidly. Within 5 minutes, you get a good effect. That included improvements and itchiness and improvement of the hives itself.”

Casale added that the clinicians themselves graded the product, when they implemented it, also as improving symptoms rapidly. Later, he was asked about the study’s noted improvements seen in patient-rated scores.

“So the patient-reported severity scale was based on how bad their itch was, on a scale of 0 to 3, and how many hives they have also from 0 to 3,” Casale said. “And both of those improved very rapidly within 5 minutes and stayed improved for 2 hours, which was the end of this particular study period.”

When asked about neffy’s possible integration as a safe and effective option for the treatment of urticaria exacerbations, Casale did clarify that it would not be the type of treatment that one would use to manage urticaria, but simply to decrease the urticaria for a relatively short period of time.

For further information, view the full interview with Casale posted above.

The quotes contained here were edited for clarity.

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