Impact of Routines and Rituals on Burden of Treatment, Patient Training, Cognitive Load, and Anxiety in Self-Injected Biologic Therapy

Disease Impact and Perception of Biologics in Adults with Type 2 Inflammation Respiratory Disease: International Survey Results

Purpose

There is a growing interest in developing approaches that reduce the impact of Type 2 inflammatory conditions, such as asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), on well-being. The aim of this international survey was to understand the impact of asthma and CRSwNP on people living with these conditions and to seek insight into the perception of biologics, which are often used to treat them.

Patients and Methods

A cross-sectional survey was conducted anonymously online from February to May 2024. International participants were recruited through social media and by Survey Monkey. Individuals aged ≥18 years diagnosed by a medical professional with asthma and/or CRSwNP who lived in the US, Canada, UK, Germany, Italy, France, or Spain were eligible to participate.

Results

Of the 1566 survey participants (56.7% asthma, 24.8% CRSwNP, 18.5% both), 52.5% were female, and 65.3% were ages 25-54 years. Approximately two-thirds (64%) reported thinking once/day or at least once/week about managing their condition. Nearly half (44%) find it difficult to manage their disease. Of those currently using a biologic (14%), only 37% inject it themselves and feel confident doing so, and 42% felt it was a repeating reminder of their chronic condition. The top reason for stopping biologic treatment was that the injection/device was too difficult. The possibility of a lower frequency injection increased the likelihood participants would consider a biologic.

Conclusion

The study further raises awareness of the personal burden from asthma and CRSwNP and their associated treatments in different countries. Beyond the goal of achieving clinical disease control for these diseases, a holistic approach to care delivery should include culturally appropriate emotional health support to improve overall well-being. Access to biologics administered with less frequency may alleviate some of the burden of self-injection.

Concizumab, a Non-Replacement Therapy for Persons with Hemophilia with Inhibitors

Despite enormous progress in the development of therapeutic agents for persons with hemophilia A and B (HA, HB), several unmet needs persist. These are disease- and treatment-related. Prophylaxis with clotting factor replacement is the gold standard, but not feasible in HA and HB with inhibitors. Whereas persons with HA with inhibitors can receive prophylaxis with a factor-mimicking agent, emicizumab, there is no recommendation for the agents to use as prophylaxis in persons with HB with inhibitors as there are no available molecules. Concizumab is a novel, subcutaneous prophylaxis option in persons with HA or HB with inhibitors that can potentially improve long-term outcomes. Here, we review the available data on concizumab and discuss its possible positioning in the armamentarium to treat hemophilia with inhibitors.

A novel injection device to administer repository corticotropin injection for inflammatory disease treatment: findings from a market research study

Aim: The goal of this market research study was to determine the usability of a single-dose prefilled injector (SelfJect™) for administration of Acthar® Gel (manufactured by Mallinckrodt Pharmaceuticals, UK) in patients with inflammatory diseases by obtaining feedback from patient and practitioner user groups in the US. Materials & methods: Patients and healthcare professionals (HCPs) representing relevant therapeutic areas were enrolled in the study between February and March 2021. SelfJect was mailed to patients and HCPs prior to 90-min virtual video-recorded focus group sessions and 60-min 1:1 virtual interviews, respectively. Patients completed an online assignment prior to the group session, which included instructions on how to use SelfJect and questions about their initial reaction while handling the device. HCPs were instructed to not open the package until the interview. Feedback from patients and HCPs were captured by open-ended questions and ranking scales. Results: Twelve patients and 42 HCPs participated in the study. Most patients (9/12 [75%]) and HCPs (38/42 [90%]) had experience with injectable medications, and 7/12 (58%) and 30/42 [71%] had experience with Acthar injections, respectively. Most patients and HCPs reported that key benefits of SelfJect were accurate dose delivery and ease of use, including the ergonomic handle and elimination of drawing Acthar from a vial into a syringe. Patients expressed some concerns about storage and disposal, but the need to store SelfJect would not deter them from using it. Most patients (9/12 [75%]) felt prepared to inject Acthar after reviewing the instructions. HCPs anticipated that 75% to 100% of patients would benefit switching from the vial to SelfJect. Conclusion: All participants expressed positive perceptions for SelfJect including easy use, few preparation steps and potential reduced anxiety due to needle phobia. These attributes may help treatment adherence for patients and caregivers.

Improvement of self-administration experience with a new injection device: Real-life experience with risankizumab in patients with psoriasis

BACKGROUND

Trypanophobia or "needle phobia" represents a potential hindrance to the effective management of chronic diseases whenever an injectable therapy might be required, especially in case of frequent administrations. Psoriasis, a chronic dermatologic disease, can be effectively treated with biologic drugs administered subcutaneously. Thankfully, anti-IL-23 drugs require few administrations per year and are available in prefilled pens that hide the needle, thus representing a convenient option in patients with trypanophobia.

METHODS

An observational multicentric study was conducted on patients with moderate-to-severe psoriasis who were treated with 75 mg × 2 risankizumab prefilled syringe therapy for more than 6 months and reported a loss of efficacy measured by the Psoriasis Area and Severity Index (PASI) from PASI 90 to PASI 75 attributed to a reduction of adherence due to trypanophobia. The patients were switched to 1 prefilled pen of risankizumab 150 mg and asked to fill out the Self-Injection Assessment Questionnaire (SIAQ) before and after the injection at week 0 and at the following administration after 12 weeks. Subjects scored each item of the SIAQ on a 5-point scale, scores were later transformed from 0 (worst experience) to 10 (best experience).

RESULTS

Twenty-two patients were enrolled. The mean SIAQ predose domain scores were 5.5 for feelings about injection, 6.2 for self-confidence, and 6.4 for satisfaction with self-injection. After dose scores were higher (> 8.5) for each of the six domains at Week 0 and even higher after 12 weeks (> 9.0).

CONCLUSIONS

User-friendly devices, such as prefilled pens, and a lower number of injections improved patient satisfaction in a group of patients with psoriasis on treatment with biologic drugs. We believe that treatment adherence could be positively influenced by such changes in the way of administration of a biologic treatment.

Towards more tolerable subcutaneous administration: Review of contributing factors for improving combination product design

Subcutaneous (SC) injections can be associated with local pain and discomfort that is subjective and may affect treatment adherence and overall patient experience. With innovations increasingly focused on finding ways to deliver higher doses and volumes (≥2 mL), there is a need to better understand the multiple intertwined factors that influence pain upon SC injection. As a priority for the SC Drug Development & Delivery Consortium, this manuscript provides a comprehensive review of known attributes from published literature that contribute to pain/discomfort upon SC injection from three perspectives: (1) device and delivery factors that cause physical pain, (2) formulation factors that trigger pain responses, and (3) human factors impacting pain perception. Leveraging the Consortium's collective expertise, we provide an assessment of the comparative and interdependent factors likely to impact SC injection pain. In addition, we offer expert insights and future perspectives to fill identified gaps in knowledge to help advance the development of patient-centric and well tolerated high-dose/high-volume SC drug delivery solutions.

Pharmaceutical and biotech industry perspectives on optimizing patient experience and treatment adherence through subcutaneous drug delivery design

Subcutaneous (SC) drug delivery can be a safe, effective alternative to the traditional intravenous route of administration, potentially offering notable advantages for both patients and healthcare providers. The SC Drug Development & Delivery Consortium convened in 2018 to raise awareness of industry challenges to advance the development of patient-centric SC drug delivery strategies. The SC Consortium identified better understanding of patient preferences and perspectives as necessary to optimize SC product design attributes and help guide design decisions during SC product development. This manuscript provides a comprehensive overview of patient-centric factors for consideration in the SC drug delivery design and development process with the aim of establishing a foundation of existing knowledge for patient experiences related to SC drug delivery. This overview is informed by the outcomes of a multi-step survey of Consortium members and key pharmaceutical stakeholders. Framed in the context of the patient's treatment journey, the survey findings offer future perspectives to fill data gaps to advance patient-centric SC drug delivery.

International Survey to Evaluate Current Options for Subcutaneous Injection of Methotrexate (MTX) and a New Button-Free MTX Autoinjector

Purpose

Prefilled syringes (PFS) and various types of pens are available for subcutaneous injection of methotrexate (MTX) in patients with rheumatoid arthritis or moderate to severe psoriasis. A new MTX pen with modernized button-free autoinjection technology was developed as a successor to a button-activated pen (metoject®/metex® PEN). To assess the needs of users and the relevance of features of the new MTX autoinjector an international online survey was performed.

Methods

A structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Participants received illustrations and information about features of the new MTX autoinjector.

Results

In total, 189 rheumatologists, 111 dermatologists, 90 nurses, and 180 patients answered the questions. Specific reasons for a preference for the use of MTX pens over PFS could predominantly be assigned to the categories "dosing/administration" and "ease of use". The first impression of the new MTX autoinjector was positive in 82% of physicians, 87% of nurses, and 76% of patients, respectively. The four most important features of the new MTX autoinjector were 2-step autoinjector mechanism (receiving a mean 14.1 to 18.1 chips of a total of 100 chips), small injection volume (9.7 to 11.7 chips), 10 different doses for dose flexibility (8.0 to 13.2 chips), and short injection time below 5 seconds (8.5 to 11.1 chips).

Conclusion

Arguments for the use of MTX pens as opposed to PFS predominantly refer to dosing/administration and ease of use. The new button-free MTX autoinjector combines a number of advantageous features identified by the international survey.

Preferences and Perspectives of Specialist Multiple Sclerosis Nurses and Patients with Multiple Sclerosis Regarding the New RebiSmart® 3.0 Autoinjector versus Other Assistive Devices

Purpose

RebiSmart® is an electromechanical multidose autoinjector developed for administering subcutaneous interferon beta-1a in patients with multiple sclerosis (pwMS). This online survey aimed to understand MS nurses' and pwMS preferences and perceptions regarding the features of an upgraded version of the RebiSmart device (RebiSmart 3.0) compared to other assistive devices used for multiple sclerosis (MS) therapy.

Patients and Methods

Eligible MS nurses and pwMS from Germany, Italy, and the United Kingdom completed a double-blind, 30-minute online self-administered questionnaire, including a 10-minute video describing the features of RebiSmart 3.0 and its use in administering interferon beta-1a.

Results

In total, 102 participants (MS nurses, n=52; patients, n=50) completed the survey. Overall, 70% respondents found the RebiSmart 3.0 device "very"/"extremely" appealing, 53% were "very"/"extremely" interested in learning more, and 71% stated they would be "very"/"extremely" comfortable using (pwMS) or educating (MS nurses) on it. Among current or recent RebiSmart 2.0 users (vs RebiSmart 2.0 nonusers), 67% (vs 52%) rated RebiSmart 3.0 "very" or "extremely" appealing, 52% (vs 43%) were "very" or "extremely" interested in learning more about the device, and 67% (vs 48%) stated they would be "very" or "extremely" comfortable using the RebiSmart 3.0 device. Respondents ranked customizable injection process (including injection speed, hold time, depth and rotation guide), self-injection process, and hidden needle as the most important self-assistive device features. RebiSmart 3.0 was rated higher than other self-injecting devices on all tested features. Overall, with respect to the top three features, 89% of the MS nurses and 73% of PwMS rated RebiSmart 3.0 "very good" or "excellent". After reviewing the video, 52% respondents had no questions, 67% nurses recommended providing more information on the customizable injection process feature of RebiSmart 3.0 to patients, and 88% nurses considered patient demonstration materials to be the most helpful type of information for them when initiating and educating pwMS on self-assistive devices.

Conclusion

The overall reactions of MS nurses and pwMS to the RebiSmart 3.0 device features were positive. The incremental advances over previous versions of the device as well as in comparison with other currently available assistive devices were welcomed. The MS nurses identified key needs for patient education on the use of the device and the suitable approaches (training videos and educational leaflets) to support MS nurses and pwMS.