Xhance is a new nasal spray to be available April 2018. Xhance is indicated for the the treatment of nasal polyps in patients 18 years or older. The active ingredient in Xhance is fluticasone propionate 93 mcg. If that sounds familiar, fluticasone propionate is the active ingredient in Flonase. What is different from Xhance from other nasal sprays is the delivery system of the medication.
The nasal spray delivers the medication “high and deep in the nasal passages, where nasal polyps originate and most sinuses drain and ventilate”, according to the company Optinose. The delivery of the medication is done by the person exhaling into the devices mouthpiece and the medicine comes out through another area into the patients nose. The device seals the nostril and allows for the transfer of pressure from the mouth into the nose. Further from the company “air then enters one nostril through the sealing nosepiece, helping expand narrow nasal passages with naturally warm, humid air.” They continue, “medication is delivered around obstructions, filling the nasal passages and depositing drug high and deep (including the ostiomeatal complex, where most polyps originate and where most sinuses drain and ventilate.”
If you have been reading our blogs, nasal polyps is a serious and chronic problem for allergy sufferers. Many patients with nasal polyps have diminished quality of life. Even when a patient does get surgery for nasal polyps, most of them seem to grow back and patients need multiple surgeries.
Of all the nasal sprays currently on the market, Nasonex is indicated for nasal polyps only. Even then though, patients taking Nasonex seem to have recurrences of their nasal polyps. According to the company “with XHANCE treatment, patients experienced statistically significant reductions of both nasal congestion/obstruction at week 4 and total polyp grade at week 16, which were the co-primary endpoints.” Other steroidal nasal sprays that are available over the counter (OTC), Nasocort, Rhinocort, Flonase Sensimist, are indicated for allergic rhinitis only
The dosing of Xhance will be 1-2 sprays per nostril twice a day. Pricing is not currently available, but it will most likely be equivalent to Nasonex. The most common side effects seen were, bleeding from the nose, nasal septum ulcers, nasopharyngitis, nasal erythema, congestion, sinusitis and headaches.
Xhance will be a prescription medication only and it will only be for nasal polyps. If you have nasal polyps and are looking for treatment options see your ENT or allergy doctor.
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Update: April 6, 2018
Xhance is now available by prescription only. Optinose the company that manufactures the medication has a copay assistance card for up to $120. Foundation Care Pharmacy in Missouri is the preferred mail order pharmacy. The cash price of the spray is approximately $400 without insurance. Coverage with insurance is variable depending on the carrier. Copay savings cards can be found here on the link below. In California, the preferred pharmacy is King’s Pharmacy and Compounding Center in Irvine, CA 92618.
Update February 7th, 2019
A recent study published in JACI January 2019, sought to assess whether Xhance was capable of high/deep drug deposition and whether it improved outcomes. Patients either got Xhance or placebo. The conclusions of the study showed improvement in:
- all cardinal symptoms (congestion/decreased smell/pain/drainage)
- evidence of inflammation (e.g. polyp grade, with some patients polyps eliminated)
- quality of life
It would be interesting to see how Xhance compares with other nasal steroid sprays, we don’t know if studies like that are coming. Qnasl and Zetonna also have a forceful delivery mechanism and head to head studies would be valuable. The authors of this study also noted a potential conflict of interest as they were paid by Optinose, the manufacturers of Xhance.