"Siri for EpiPen": New epinephrine injector Auvi-Q challenges market leader with voice, shape, cool factor

Here are some excerpts from the NYTimes (with my comments below):

All epinephrine autoinjectors contain the same medication

Both the Auvi-Q and EpiPen contain the drug epinephrine, which can halt a severe allergic reaction, known as anaphylaxis.

Auvi-Q is the culmination of a single-minded quest that began 15 years ago and ended in a $230 million licensing deal with the French pharmaceutical giant Sanofi.

It boldly challenges the superiority of the EpiPen at a time when food allergies among children and teenagers are on the rise.

The two brief videos below show the instructions for use of Auvi-Q vs. EpiPen, and you can compare them for yourself.

This 2-minute video shows the Sanofi's new voice guided Auvi-Q epinephrine injector in action:



Video instructions on use of the EpiPen (epinephrine/adrenaline) autoinjector for anaphylaxis from the Australasian Society of Clinical Immunology and Allergy (ASCIA):



New epinephrine injector Auvi-Q challenges market leader with voice, shape, cool factor

Auvi-Q will appeal to a gadget-hungry generation with its compact, rectangular design and automated voice instructions that guide a user through the injection process. One food allergy patient called the new Auvi-Q epinephrine injector "Siri for EpiPen" (Siri is Apple's voice-enabled personal assistant). Auvi-Q comes with a downloadable app for iPhone/iPod/iPad, and soon, for Android.

Auvi-Q website offers a lot of useful resources

The Auvi-Q website features many helpful materials including a list of questions for your doctor (PDF). The Allergy ID Card and Eating Out Card are very helpful but the Action Plan is poorly designed and somewhat confusing (PDFs). The generic action plan available from the FAAN website is preferable (PDF). I use a modified version of the action plan (embedded below) and added the Auvi-Q to the list of the injectors:



Auvi-Q has generated a lot of positive feedback

Auvi-Q has created a stir among allergy sufferers, including bloggers and others who have praised its compact design and “cool” factor. It is smaller than a deck of cards.

You can quickly realize the best feature of the device. Just give the Auvi-Q to anyone and ask them to figure how to use it by themselves. Once they pull the cover, the voice navigation kicks in and they will be done in 10 seconds. It is nearly impossible to achieve this quick understanding with the previous epinephrine injectors.

EpiPen is a reliable device - Auvi-Q looks like the 2nd generation of autoinjectors

The EpiPen CEO is not so impressed by Auvi-Q: "“EpiPen has been tried and true for 25 years,” Ms. Bresch said, and argued that her product’s distinctive shape worked to its advantage. “It’s not easily confused with a BlackBerry or your phone in your purse or your backpack.”

However, “People might find it easier to have that in a pocket compared to carrying a giant Magic Marker,” said one prominent allergist, Dr. Sicherer.

Sanofi has set a price for the Auvi-Q that is comparable to the EpiPen, charging $240 for two auto-injectors and a training device.

Still, the Auvi-Q faces long odds: several other companies have tried and failed to challenge the dominance of the EpiPen. Last year, the manufacturer of the only competing products on the market, the Adrenaclick and Twinject, announced it would stop making them.

Does Auvi-Q work if the battery is down?

Yes. The mechanical component that injects epinephrine is independent of the electical component that provides voice ibstructions.

How much does Auvi-Q cost?

The price for Auvi-Q is $240 for two auto-injectors and a training device. This a bit less expensive than EpiPen ($250 to $300 for EpiPen 2-pack). Sanofi provides coupons from the Auvi-Q website that bring the price of Auvi-Q down to $25 per prescription for patients with commercial insurance.

How big is the Auvi-Q needle?

The size of the Auvi-Q needle 23 Gauge (G). This is reportedly one Gauge thinner needle than EpiPen. Here is a Needle gauge comparison chart from Wikipedia: http://bit.ly/V8NKeW

Is there a "Junior" version of Auvi-Q?

Auvi-Q comes in the same doses as EpiPen. There is no "Junior" label, which is a good thing, because a lot of "junior" patients actually need adult epinephrine doses based on their weight. Patients over 30 kg (66 lbs) need 0.3 mg of epineprine (Auvi-Q 0.3 or EpiPen). Patients less than 30 kg need 0.15 mg of epineprine (Auvi-Q 0.15 or EpiPen Junior).

Summary and personal experience

Auvi-Q is a well-designed device that looks like the second generation of epinephrine autoinjectors. There is nothing inherently wrong with EpiPen. There was nothing wrong with the first generation iPod, the one with the click-wheel. However, the all-screen iPod Touch was a leap in technology that made the first generation almost obsolete.

EpiPen has been on the market for 25 years and it is exceedingly reliable. However, many patients never need to use their autoinjector. Then, when they really, really need to use it, they either do not have it with them, or have forgotten how to use it. Auvi-Q is similar in shape and size to a cell phone. This is an advantage. Most teenagers (one of the most vulnerable groups for food-induced anaphylaxis) carry their phones everywhere. It seems more likely that they would carry a device similar to what they are already wearing rather than a "giant marker". Also, when they are scared and every second counts, the calm voice-guided instructions of the Auvi-Q will help. It is not surprising that the AEDs have voice-guided instructions too.

Finally, it is all about the patients. Doctors almost never use epinephrine autoinjectors (unless they are patients). Patients do. It is not for us as physicians to decide. During the past several weeks, I have shown both Auvi-Q and EpiPen to new and established patients with food allergy. The majority of them choose Auvi-Q because of its voice-guided instructions, shape, size, and yes, cool factor. Always trust your patients. Because when the time comes to save a life, they should have a device that is reliable and easy to use. Help them make that decision.

References:

Auvi-Q Challenges EpiPen With a New Shape and Size - NYTimes.
Image source: http://auvi-q.com

Adults, caregivers, and children prefer the Auvi-Q design over the EpiPen design - JACI abstract http://buff.ly/Ybl0PR
How easy to use is Auvi-Q epinephrine autoinjector? 95% of children were successful on first attempt (mean age 11) http://buff.ly/13awHiK

Comments from Twitter:

Dr John Weiner @AllergyNet: Superb review by @Allergy New adrenaline injector Auvi-Q challenges market with voice, shape, cool factor buff.ly/14LMnpA

Sharon Desserud @SDesserud: Available in Canada? Cost comparison? Are you having trouble getting Twinject in US?

Fibi B @FibiJeebi: Epi-pens are all ready super expensive. That isn't going to help. We don't need cool, we need affordable.

Dr. Ellis @DrAnneEllis: EpiPen or Auvi-Q (i.e. Allerject)? Blog post by @Allergy shows pros/cons of both with instructional videos

A Russell BSN RN AEC @AllergyEducator: @Allergy compares/contrasts EpiPen w/ Auvi-Q -the newest epi autoinjector entering the market

FoodAllergySupport @FASupport: This is so good to know. "Does Auvi-Q work if the battery is down?"

Katy McFall @kmcfall: Great to know!

Dr John Weiner @AllergyNet: Great review, good links

Updated: 03-19-2013

5 comments:

  1. Well written article! I think as we move forward in time, we'll discover the challenges, such as will a babysitter be confused if there are two devices in a home? As well as school nurses. Also, how many Auvi-Q's might end up in the toilet by accident.

    On the other hand, my 14 year old is thrilled since he struggles to carry two epi pens and an in haler in his pockets! I think both products will meet the needs of many.

    Again, very well written article! Thank you for helping raise awareness.

    ReplyDelete
  2. I just need to make one more comment: I truly appreciate, as a patient that Dr. Dimov is asking fellow physicians to turn to their patients in regards to choosing a life saving device. They are the end users and their ability to successfully use their auto injector is the difference between life and death.

    ReplyDelete
  3. Anonymous3/07/2013

    I am very excited as a school nurse to have gotten my hands on this trainer. As a mom with a child of allergies, this will be replacing our personal units to help a squeemish dad get through his phobia of using!

    ReplyDelete
  4. Anonymous5/15/2013

    Why are these things so expensive! It's outrageous. There around 75 millions Americans who are at risk and only a small fraction of that get the prescriptions....in large part because of the cost. You have to spend $300 a year for a medicine that you most likely will not need. Most people will opt to take the risk.

    ReplyDelete
  5. Anonymous8/25/2013

    Frustration...when insurance companies will not cover this product... yea cost is a factor! Knowing that we need have something, but the cost is so far out of reach for the people who can't afford over $300 for something that will hopefully never have to be used. I agree with Anonymous (5/15/2013) most will opt to take the risk and go without.

    ReplyDelete

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