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Background The study aimed to assess 52-week efficacy and safety of secukinumab self-administration by autoinjector in patients with active psoriatic arthritis (PsA) in the FUTURE 3 study ( ClinicalTrials.gov NCT01989468). Methods Patients (≥ 18 years of age; N = 414) with active PsA were randomized 1:1:1 to subcutaneous (s.c.) secukinumab 300 mg, 150 mg, or placebo at baseline, weeks 1, 2, 3, and 4, and every 4 weeks thereafter. Per clinical response, placebo-treated patients were re-randomized to s.c. secukinumab 300 or 150 mg at week 16 (nonresponders) or week 24 (responders) and stratified at randomization by prior anti-tumor necrosis factor (TNF) therapy (anti-TNF-naïve, 68.1%; intolerant/inadequate response (anti-TNF-IR), 31.9%). The primary endpoint was the proportion of patients achieving at least 20% improvement in American College of Rheumatology response criteria (ACR20) at week 24. Autoinjector usability was evaluated by Self-Injection Assessment Questionnaire (SIAQ). Results Overall, 92.1% (300 mg), 91.3% (150 mg), and 93.4% (placebo) of patients completed 24 weeks, and 84.9% (300 mg) and 79.7% (150 mg) completed 52 weeks. In the overall population (combined anti-TNF-naïve and anti-TNF-IR), ACR20 response rate at week 24 was significantly higher in secukinumab groups (300 mg, 48.2% ( p < 0.0001); 150 mg, 42% ( p < 0.0001); placebo, 16.1%) and was sustained through 52 weeks. SIAQ results showed that more than 93% of patients were satisfied/very satisfied with autoinjector usage. Secukinumab was well tolerated with no new or unexpected safety signals reported. Conclusions Secukinumab provided sustained improvements in signs and symptoms in active PsA patients through 52 weeks. High acceptability of autoinjector was observed. The safety profile was consistent with that reported previously. Trial registration ClinicalTrials.gov NCT01989468 . Registered 21 November 2013. EudraCT 2013–004002-25 . Registered 17 December 2013.

Purpose Cavitation is an undesired phenomenon that may occur in certain types of autoinjectors (AIs). Cavitation happens because of rapid changes of pressure in a liquid, leading to the formation of small vapor-filled cavities, which upon collapsing, can generate an intense shock wave that may damage the device container and the protein drug molecules. Cavitation occurs in the AI because of the syringe-drug relative displacement as a result of the syringe’s sudden acceleration during needle insertion and the ensuing pressure drop at the bottom of the container. Therefore, it’s crucial to analyze the potential effect of cavitation on AI. The goal of the current study is to investigate the effects of syringe and AI design parameters such as air gap size, syringe filling volume, fluid viscosity, and drive spring force (syringe acceleration) on the risk and severity of cavitation. Methods A model autoinjector platform is built to record the syringe and cavitation dynamics which we use to estimate the cavitation intensity in terms of extension rate and to study the effects of design parameters on the severity of cavitation. Results Our results show the generation of an intense shock wave and a high extension rate upon cavitation collapse. The induced extension rate increases with syringe acceleration and filling volume and decreases with viscosity and air gap size. Conclusion The most severe cavitation occurred in an AI device with the larger drive spring force and the syringe of a smaller air gap size filled with a less viscous fluid and a larger filling volume.

Subcutaneous injection of monoclonal antibodies (mAbs) has experienced unprecedented growth in the pharmaceutical industry due to its benefits in patient compliance and cost-effectiveness. However, the impact of different injection techniques and autoinjector devices on the drug’s transport and uptake is poorly understood. Here, we develop a biphasic large-deformation chemomechanical model that accounts for the components of the extracellular matrix that govern solid deformation and fluid flow within the subcutaneous tissue: interstitial fluid, collagen fibers and negatively charged proteoglycan aggregates. We use this model to build a high-fidelity representation of a virtual patient performing a subcutaneous injection of mAbs. We analyze the impact of the pinch and stretch methods on the injection dynamics and the use of different handheld autoinjector devices. The results suggest that autoinjector base plates with a larger device-skin contact area cause significantly lower tissue mechanical stress, fluid pressure and fluid velocity during the injection process. Our simulations indicate that the stretch technique presents a higher risk of intramuscular injection for autoinjectors with a relatively long needle insertion depth.

A Comparative Use Human Factors study was conducted to assess whether the injection success rate (SR) with biosimilar adalimumab-fkjp (Bios-ADA) autoinjector (Hulio®) is comparable to reference adalimumab (Ref-ADA) autoinjector (Humira®), accounting for design differences, including the absence of an activation button, to evaluate usability in the target patient population. A counterbalanced, multicenter study was conducted under simulated conditions, with patients completing multiple steps to administer the medication (40 mg Bios-ADA or Ref-ADA) into an injection pad using both devices. The endpoint was the overall SR for completing critical delivery system tasks with each device. A total of 55 patients (50 adults with rheumatoid arthritis and five patients with juvenile idiopathic arthritis and/or pediatric Crohn's disease) were enrolled. The overall SR for patients using the Bios-ADA autoinjector and the Ref-ADA was 92.7% (51/55) and 87.3% (48/55), respectively. Four and seven use errors were observed with the Bios-ADA and Ref-ADA autoinjectors, respectively. Bios-ADA autoinjector was non-inferior to Ref-ADA autoinjector, and design differences did not introduce clinically significant use-related risks. The Bios-ADA autoinjector can be used as a practical alternative to the Ref-ADA autoinjector from a usability perspective, with comparable overall performance during self-administration.

Ustekinumab is approved for treating moderate to severe plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. The Bmab 1200 autoinjector is a simple, two-step device for subcutaneous ustekinumab biosimilar delivery. This was an in vitro, nonclinical, simulated-use human factors validation study to evaluate if intended users could safely and effectively use it. Ninety participants (recruited via purposive sampling) were enrolled (mean age: 43 years; range: 12-72 years), including adult and adolescent patients, lay caregivers, and healthcare professionals. Without formal training, participants performed simulated injections into foam pads. Test personnel observed, documented, debriefed, and reported any errors made by participants while completing assigned tasks and sub-tasks. Each participant was observed throughout the session and observational and performance data were collected in real time by data logger. Performance measures included injection success rates, use errors, and 24 knowledge tasks. Across these knowledge tasks, participants were required to locate, identify, and understand 28 distinct measures. Participants also provided feedback on usability and confidence levels. All participants (100%) completed unaided dose injections. A total of 20 use errors were documented: hand hygiene (  = 8), site preparation (  = 5), and device handling (  = 7), none causing device damage or failed delivery. The knowledge task success rate was 99.6% (2,511/2,520 measures). Nine use errors (study artifacts or inattention to instructions) occurred only among caregivers. All participants expressed confidence in safe dosing and found the device user-friendly. The Bmab 1200 autoinjector demonstrated high usability and safety across diverse users for ustekinumab biosimilar delivery in chronic autoimmune conditions.

ObjectivePre-filled syringes (PFSs) have become popular as a convenient and cost-effective container closure system for delivering biotherapeutics. However, standard siliconized PFSs may compromise the stability of therapeutic proteins due to their exposure to the silicone oil–water interface. To address this concern, silicone oil-free (SOF) glass syringes coupled with silicone-oil free plunger stoppers have been developed. This study aims to compare the impact of silicone oil-free (SOF) and siliconized syringes as primary container on protein stability and device functionality of the combination products.MethodsThe stability of proteins with different modalities was assessed in SOF and siliconized 1 mL glass syringes for up to 6 months at 5℃, 25℃, and 40℃ with levels of subvisible particles and soluble aggregate determined by micro-flow imaging (MFI) and ultra performance size-exclusion chromatography (UP-SEC). The functionality of SOF glass syringes, including break loose force, extrusion force and delivery time in autoinjectors, was evaluated at different time points during the stability study. Additionally, SOF glass syringes were filled with viscosity surrogate ranging from 1 to 90 cP to understand the impact of solution viscosity on break loose force, extrusion force, and autoinjector delivery time.ResultsSOF demonstrates compatibility with proteins and exhibited significantly low particle counts compared to siliconized PFS. SOF syringes show significantly higher break-loose and extrusion forces. However, unlike siliconized syringes where silicone oil migration increases extrusion force, no significant change in functionality was observed in SOF glass syringe during stability testing. Overall, SOF glass syringes showed great potential as an alternative package for biologics with comparable performance on functionality as siliconized PFS.ConclusionsThe combination of SOF glass and its PTFE coated stopper presents a new primary container closure system with both adequate protein stability and desired functionality features.

The subcutaneous delivery of biologics using pre-filled autoinjector devices continues to attract broad scholarly interests. However, research still lacks a detailed understanding of user perceptions as the basis for specifying the clinically relevant technical attributes of a device, such as the cap-removal force. Therefore, this article studies the ability of users to remove the autoinjector cap, as well as the effects of the cap-removal force and user characteristics on the perceived ease of decapping. Forty-two participants among patients, caregivers, and healthcare professionals removed the protective cap using non-functional devices with different target cap-removal forces between 25 N and 55 N. Data were collected on the ability of the users to effectively decap the device and their perceived ease of decapping. Linear regression was then applied to quantify the impact of the decapping force and patient characteristics on the perceived ease of decapping. The participants of the study effectively decapped all autoinjector devices irrespective of age, sex, and dexterity impairments. Moreover, the study reveals that the perceived ease of decapping decreases significantly with increasing decapping force and participants' dexterity impairments. The study provides initial empirical evidence on the ability of users to decap autoinjector devices and shows how increasing the cap-removal force and dexterity impairments reduce the perceived ease of decapping.

•Autoinjector devices have been developed to make self-injection easier.•Autoinjectors increase adherence over long treatment durations for patients.•Lebrikizumab administration via autoinjector was bioequivalent to prefilled syringe. Lebrikizumab is a novel, high-affinity immunoglobulin G4 monoclonal antibody that targets interleukin-13, a central mediator in atopic dermatitis (AD). In previous studies in patients with moderate-to-severe AD, lebrikizumab, administered subcutaneously via a prefilled syringe with a needle safety device (PFS-NSD), demonstrated rapid and durable dose-dependent efficacy. We assessed the pharmacokinetics and safety of lebrikizumab using either a PFS-NSD or an investigational autoinjector. Such devices have been developed to make self-injection easier for patients, thus increasing adherence over long treatment durations. The current study compared the pharmacokinetics and safety of 250 mg lebrikizumab (2 mL of a 125-mg/mL solution) administered subcutaneously at 1 of 3 different injection sites (abdomen, arm, or thigh) in 241 healthy participants using either a PFS-NSD (N = 122) or an investigational autoinjector (N = 119). Statistical analysis demonstrated 2-mL (125 mg/mL) lebrikizumab autoinjector was bioequivalent to 2-mL (125 mg/mL) lebrikizumab PFS-NSD as 90% CIs of the geometric least squares means ratios for lebrikizumab AUC(0-tlast), AUC(0-∞), and Cmax were all completely contained within the prespecified confidence limits of 0.80 and 1.25. Injection-site location did not appear to impact lebrikizumab systemic exposure for either device. Lebrikizumab was well tolerated with no SAEs reported after PFS-NSD or autoinjector administration. Bioequivalence was demonstrated between 250 mg lebrikizumab 2-mL autoinjector and prefilled syringe devices, showing both devices to be suitable options for administering lebrikizumab.

PurposeInterface motion and hydrodynamic shear of the liquid slosh during the insertion of syringes upon autoinjector activation may damage the protein drug molecules. Experimentally validated computational fluid dynamics simulations are used in this study to investigate the interfacial motion and hydrodynamic shear due to acceleration and deceleration of syringes. The goal is to explore the role of fluid viscosity, air gap size, syringe acceleration, syringe tilt angle, liquid-wall contact angle, surface tension and fill volume on the interface dynamics caused by autoinjector activation.MethodsA simplified autoinjector platform submerged in water is built to record the syringe and liquid motion without obstruction of view. The syringe kinematics is imported to the simulations based on OpenFOAM InterIsoFoam solver, which is used to study the effects of various physical parameters.ResultsThe simulations agree with experiments on the air-liquid interface profile and interface area. The interfacial area and the volume of fluid subject to high strain rate decrease with the solution viscosity, increase with the air gap height, syringe velocity, tilt angle and syringe wall hydrophobicity, and hardly change with the surface tension and liquid column height. The hydrodynamic shear mainly occurs near the syringe wall and entrained bubbles.ConclusionFor a given dose of drug solution, the syringe with smaller radius and larger length will generate less liquid slosh. Reducing the air volume and syringe wall hydrophobicity are also helpful to reduce interface area and effective shear. The interface motion is reduced when the syringe axis is aligned with the gravitational direction.

Background Worldwide, guidelines recommend the use of adrenaline autoinjectors (AAIs) for self-medication in patients who experience severe allergic reaction. The European Medical Agency recommends the prescription of two AAIs, which should be carried by patients at all times. The European Academy of Allergy and Clinical Immunology guidelines propose to prescribe a second AAI under some defined conditions. In the present study, we aimed to examine the adherence to these guidelines and prescription behavior of allergy experts regarding the number of AAIs prescribed for a given patient. Methods A standardized questionnaire was applied to the participants of the 5th International Conference of the Network of Online Registration for Anaphylaxis (NORA e. V.). Twenty-six experts (medical doctors with at least 2 years of experience in the field of anaphylaxis) answered the questions regarding the number of autoinjectors prescribed and the reasons influencing their decisions. Results Sixty-eight percent of the experts usually prescribed one AAI, while 32% prescribed two. The pediatricians and physicians with less experience tended to prescribe two autoinjectors more frequently. The experts were more likely to prescribe two adrenaline autoinjectors if the patient was a child, had a previous severe reaction, had mastocytosis, asthma, cardiovascular disease, or high body weight, or lived far from the emergency department. Conclusion Our data confirm the lack of consensus regarding the number of AAIs to prescribe. Despite the European Medical Agency recommendation, the majority of allergy experts prescribed one autoinjector per patient. However, under distinct circumstances (e.g. mastocytosis, asthma, excess body weight, a history of severe anaphylaxis, or restricted access to immediate emergency), experts tended to prescribe more AAIs, which is in accordance with the European Academy of Allergy and Clinical Immunology guidelines.