Citation: Guilliouma W, “Sensor Advancements in Drug Delivery Improve Compliance”. ONdrugDelivery Magazine, Issue 107 (May 2020), pp 25-28.
Bill Guilliouma looks at the role of platform training solutions for patient onboarding and adherence to treatment regimens.
With more biologics and drug delivery device options entering the market in recent years, pharma companies can decide whether it would be easier for patients to self-inject with an autoinjector or prefilled syringe, depending on drug viscosity and other factors. Some biologics also offer patients and their healthcare providers (HCPs) the ability to choose between the two drug delivery devices, depending on patient preference and ability.
“The autoinjector platform is created after a specific device but pharma companies can use their own branding and other specifications for customisation, such as injection time, plunger location and labels.”
A recent study found that 77% of patients who self-inject biologics at home prefer to use an autoinjector when administering their therapy rather than a prefilled syringe. There are many reasons for this but chief among them is that 95% of the patients from the study consider autoinjector use “extremely easy or easy”, whereas 74% of these patients said the same was true for prefilled syringes. What’s more, 89% of these patients reported a “favourable or extremely favourable” overall impression of autoinjector use, compared with 73% of patients saying the same for prefilled syringes.1
These statistics support Noble’s ongoing effort to create best-in-class patient training devices that replicate the exact form and function of true autoinjectors for patients to practise at home. To achieve our goal of creating top-tier training devices for patients, we continue to develop and launch platform training solutions, which offer benefits such as speed to market, lower cost of entry and the ability to customise the training devices to brand specifications.
Think of these platform training solutions like a car assembly line. The main, larger parts of one make of car are the same – like a car chassis – and can be quickly put together. Once the frame is in place, various other parts of the car are easily assembled and more customisable. For example, buyers can choose between various engines, whether they want two- or four-wheel drive, and what colour they want – but the main framework of the car is the same.
Noble’s platform training solutions mimic this process: the autoinjector platform is created after a specific autoinjector drug delivery device but pharma companies can use their own branding and other specifications for customisation, such as injection time, plunger location and labels.
There are many advantages to these platform training solutions. As mentioned, speed to market is a key benefit. Secondly, pharma companies can customise their training devices to their brand guidelines and product specificity. Meanwhile, Noble ensures that accurate injection time simulation, auditory feedback and so on replicate that of the true drug delivery device. This ensures the most realistic training experience possible. Our platform training solutions use our patented technologies to provide repeatable and reliable training experiences. All platform products are developed and tested under Noble’s ISO 9001-certified quality management system.
YPSOMATE AUTOINJECTOR PLATFORM
One of Noble’s platform training solutions is based on Ypsomed’s 1 mL and 2.25 mL automated, disposable two-step YpsoMate autoinjectors.
Noble’s YpsoMate training platform (Figure 1) replicates the real device and incorporates innovative features that are intended to give patients a realistic and repeatable simulated injection experience.
These proprietary features, which are not found in other training devices, further support patients during their self-injection journey by offering an even more realistic injection simulation.
OVERCOMING FEAR TO IMPROVE OUTCOMES
It is widely understood that approximately 20% of the world’s population has some degree of needle fear, while 10% of people are so fearful of needles they’re categorised as having trypanophobia – a phobia of needles. This fear of needles is higher the younger a patient is and tends to decrease as patients get older.2
“As pharma companies develop therapies that permit longer intervals between injections, and therefore improve the patient experience, patients risk forgetting critical proper injection steps and losing the confidence needed to self-inject.”
Additionally, this fear causes 45% of patients who rely on self-injection therapies to either skip or cease their injections. To acclimate patients to the feeling of the needle prick, Noble’s YpsoMate training devices have the option to incorporate a patented agitator tip option. This feature slightly pricks – but does not at all puncture – the skin at the start of the injection to create the sensation at the injection site. Noble’s agitator tip can replicate varying needle forces and ranges, depending on what the pharma company needs to best replicate its drug delivery device experience.
This helps patients mentally prepare for the timing and sensation of needle insertion to help build confidence when self-injecting. In addition, patients are less likely to experience a wet injection, which occurs when patients remove the needle before the full dose has been delivered from the device – which can impact the efficacy of the drug.
So why does Noble invest time, money and energy in creating training solutions for pharma companies? Because, at the end of the day, these training solutions reach patients worldwide and help them achieve the confidence to properly self-inject and attain full efficacy from their therapies.
There are several factors that play into patients’ potential for self-injection therapy non-adherence. The first is a longer period between injections at home. For example, in psoriasis, AbbVie’s Humira (adalimumab) is injected every two weeks, whereas AbbVie and Boehringer Ingelheim’s Skyrizi (risankizumab), which was more recently approved, is injected every 12 weeks. As pharma companies develop therapies that permit longer intervals between injections, and therefore improve the patient experience, patients risk forgetting critical proper injection steps and losing the confidence needed to self-inject. This 12-week decay period in the example case of Skyrizi, during which patients are not injecting, introduces the training risks associated with the forgetting curve.
The forgetting curve theory posits that, without practice and repetition, retention and recall of information degrade over time – strikingly. The theory finds that half of newly learned information is already forgotten in one hour. That means, by the time the patient gets home after receiving injection training from their HCP, they have already lost half the information needed to inject properly. This patient memory decay has the potential to lead to increased injection errors as patients forget critical steps. To combat this, training devices can be used not only directly before injecting but also between injections.4
SURVEYS HIGHLIGHT IMPORTANCE OF TRAINING
A Noble survey sent to HCPs who work with patient groups most often prescribed self-injectable biologics – such as rheumatologists and gastro-enterologists – found that these HCPs value training for their patients but are still not doing it. This occurs for many reasons, chief among them that HCPs themselves are not being trained. Specifically, the survey found that 43% of HCPs don’t receive any device training.5
What’s more, 71% of HCPs said they would be “very likely” to prescribe a self-injected medication that came with a robust training solution for their patients.
Noble’s YpsoMate training platform includes more than just the training device that replicates Ypsomed’s YpsoMate autoinjector. It also includes training instructions for use (IFU) that also teach users how to reset the training device for future use (Figure 2). There is also an option to include a how-to video demonstrating proper use of the training device. These elements work together to prepare patients properly for the true injection.
The survey also uncovered many other statistics that point to how useful training solutions can be for patients:
- 91% of HCPs believed patients would be more confident self-injecting if they had a training device to practise with between injections and immediately prior to injecting
- 88% of HCPs believed patients would experience less anxiety self-injecting if they had robust training solutions as support
- 89% of HCPs believed patients would be more adherent to their therapies with the support of training solutions. This increased adherence to therapies can lead to patients staying on one specific therapy longer – realising greater therapy efficacy and, for pharma, increasing patient retention.
“Patients surveyed believed HCPs were focused on disease treatment but not the overall patient experience.”
Even while HCPs agreed that training solutions are imperative for patients who self-inject, the same survey found that 50% of patients who received training in an HCP office were only trained once for 10 minutes or less and rarely sent home with a training device for ongoing practice.
Another survey, from 2017, reiterates the above findings from the HCP survey but from a patient perspective, shedding light on the importance of training. The survey uncovered four common problems in the overall healthcare that patients received – most notably that patients were not empowered and often felt they lacked input in their therapies, information and control in treatment decisions. This goes hand in hand with the HCP survey findings that stated HCPs find value in training but simply don’t have the time and tools available to do it.6
Even more striking was that patients surveyed believed HCPs were focused on disease treatment but not the overall patient experience, and that HCPs didn’t fully explain how to perform injections, leaving patients to figure it out via trial and error. This corroborates HCPs’ admissions that, if they train their patients at all, they only do so for a maximum of 10 minutes due to time constraints.
PLATFORM SOLUTIONS POISED TO HELP
With both HCPs and patients confirming the value of training for patients who self-inject, but an extremely restrictive amount of time for training in-office, how can stakeholders ensure patients receive the support they deserve?
Noble’s platform solutions are designed to help, by being quick to market and less expensive than bespoke solutions. Training devices allow patients to take ongoing training with them, relying less on one-off training in an HCP office.
Noble’s platform solutions, like the Ypsomed YpsoMate autoinjector platform, are created to ensure patients and HCPs are provided with these training resources to help patients start on a therapy that works for them sooner and that they stay on longer, realising full therapy efficacy and helping them live a longer, happier, healthier life.
- Vermeire S et al, “Preference for a prefilled syringe or an auto-injection device for delivering golimumab in patients with moderate-to-severe ulcerative colitis: a randomized crossover study”. Patient PreferAdherence, 2018, Vol 12, pp 1193–1202.
- McLenon J, Rogers M, “The fear of needles: A systematic review and meta‐analysis”. J Adv Nurs, 2019, Vol 75(1), pp 30–42.
- Zambanini A, Newson R, Maisey M, Feher M, “Injection related anxiety in insulin-treated diabetes”. Diabetes Research and Clinical Practice, 1999, Vol 46(3), pp 239–246.
- Kohn A, “Brain science: The forgetting curve–the dirty secret of corporate training”. Learning Solutions, March 13, 2014.
- Patient Study, Noble, 2017.