RESUMO
INTRODUCTION: Etanercept is effective in the management of rheumatoid arthritis (RA) and can be self-administered via an auto-injector. While these devices are generally well accepted, some patients are not comfortable with the process of self-administration; this has been cited as a reason for discontinuation of biologic treatment. Alternative routes of administration (e.g., infusion) are more resource intensive. The aim of this analysis was to explore the attributes of auto-injection devices that impact patient confidence and ability to self-administer. METHODS: Patients with RA (n = 168) and healthcare providers (n = 82) in Belgium, Germany, Japan, Spain, and the UK were interviewed (n = 250 overall). Mock injection procedures were carried out using an auto-injector device with the addition of a sleeve with a wider rubber grip. Importance of and performance of the device against a range attributes were captured using a Likert scale (1-7). Disease severity was captured using the Cochin hand function scale. RESULTS: Device attributes reported by patients to be most important were 'use without assistance' 'ease of administration', 'ease of operation', and 'ease of grip'. The device with additional sleeve performed strongly against these attributes, scoring 6.9 (out of 7), 6.8, 6.8, and 6.6, respectively with no difference observed between countries. Nurses and physicians reported similar responses. Qualitatively, patients reported that stability and grip provided a sense of control and reduced anxiety. Similar overall 'ease of operation' was reported between patients with mild (n = 89) or moderate/severe (n = 71) disease (score 6.4 vs. 6.5, respectively). CONCLUSIONS: The auto-injector plus sleeve performed strongly against key attributes even in patients with moderate/severe RA and patients with reduced grip strength. The robust grip improved patient confidence and reduced injection-related anxiety. This may be beneficial in patients who are anxious about self-administration, those new to self-administration, and potentially in patients with reduced hand dexterity as a result of either advanced disease or a painful day.
Etanercept is a medicine used to treat rheumatoid arthritis that is given by injection. It can be delivered by patients themselves, in their own homes, using an auto-injection device that looks like a pen. Some patients are not comfortable with the process of self-injecting. Other patients have severe arthritis in their hands that stops them from carrying out self-injection. One auto-injection device (MyClic) has been enhanced by the addition of a sleeve that fits over the top of the pen. This was shown to 168 patients with rheumatoid arthritis, who already use the MyClic 'pen' and 82 doctors and nurses in five countries (Belgium, Germany, Japan, Spain, and the UK). Patients, nurses, and doctors said what they believed to be the most important features of a self-injection device. Generally, patients, nurses, and doctors from the different countries had similar views. Next, the participants scored the modified auto-injection device against those features. The device plus sleeve scored highly, meaning that patients, nurses, and doctors believed it would work well for the patient population tested. Many patients said that with the added sleeve, the self-injection device was more stable and they were able to grip it better. This helped to make patients feel in control and reduced any anxiety or fear they were feeling about their self-injection. This suggests that the sleeve is a useful addition and may be particularly useful for patients who are nervous about self-injection or have difficulty gripping self-injection devices because of their arthritis.
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PURPOSE: A novel device (sleeve) has been developed that attaches to compatible autoinjectors and is designed to improve the patient experience, particularly for those with limited manual dexterity. This study was designed to explore whether user experience is improved when using the Enbrel® MyClic® autoinjector in conjunction with the sleeve. The Enbrel MyClic autoinjector contains etanercept (Enbrel®), a biologic drug that patients self-administer subcutaneously for the treatment of rheumatoid arthritis (RA). PATIENTS AND METHODS: Twenty-four adult patients (16 female) with RA and varying degrees of manual dexterity impairment took part in this user study. Written informed consent was supplied by each patient prior to performing the study. They each performed two simulated injections into skin pads, one with the Enbrel MyClic alone and the other with the Enbrel MyClic + sleeve. Following the simulated injections, participants answered questions about their experience of using the sleeve and rated the following on a scale of 1 (poor experience) to 7 (optimal experience): overall use; ease of preparation; ease of administration; ease of learning to use; look, feel and size of the device; overall experience. RESULTS: Participants rated the Enbrel MyClic + sleeve more highly than the Enbrel MyClic alone for overall use, ease of administration, feel, size and overall experience. Participants with severe dexterity impairment (n = 12) were more likely to rate these features as better with the sleeve in place than those with mild dexterity impairment (n = 10). Three-quarters of participants said they would request the sleeve if it became available and all said that they would recommend it to others. The main benefits cited by participants were better grip and a better feeling of control. CONCLUSION: Addition of the sleeve improved patients' experience of using the Enbrel MyClic. The benefits of the sleeve outweighed any inconvenience associated with the additional steps needed to prepare the device.