https://orcid.org/0000-0002-1557-3413
Abstract
Background
For many chronic immune system disorders, the available treatments provide several options for route of administration. The objective of this systematic literature review is to inform discussions about therapy choices for individual patients by summarizing the available evidence regarding the preferences of patients with chronic immune system disorders for intravenous (IV) or subcutaneous (SC) administration.
Methods
Searches of the MEDLINE, Embase and Cochrane Library databases were conducted using terms designed to capture studies reporting patient preferences between IV and SC therapy published in English. Relevant studies were limited to those in which mode of administration, including treatment frequency and setting, was the main difference between comparators.
Results
In total, 49 studies were included in the review. Among 18 studies that compared IV and SC immunoglobulin therapy, 16 found patients to prefer the SC administration route. The results of the 31 studies comparing IV infusion and SC injection of non-immunoglobulin therapies were mixed, with patients favoring SC administration in 20, IV infusion in seven, and having no overall preference in four. Patient experience had a strong effect on preferences, with treatment-experienced patients preferring their current administration route in most studies. Patients preferring SC administration tended also to prefer treatment at home, mainly due to the convenience and comfort of home treatment and the avoidance of having to attend hospital. By contrast, patients preferring IV infusion tended to cite the lower treatment frequency and a dislike of self-injecting, and preferred hospital treatment, mainly due to the presence of healthcare professionals and resulting feelings of safety.
Conclusion
In general patients with chronic immune system disorders tend to be more likely to choose SC administration than IV infusion, but preferences may vary according among individuals. These findings may assist discussions around appropriate treatment choices for each patient.
Acknowledgments
This study was funded by UCB Pharma. The authors acknowledge Veronica Porkess of UCB Pharma, for publication and editorial support, and Claire Mulligan of Beacon Medical Communications Ltd, for systematic review screening.
Disclosure
Jeffrey Allen has acted as a consultant for Argenx, Akcea Therapeutics, CSL Behring and Grifols. He has also received grants from CSL Behring, personal fees from Grifols, and personal fees from Argenx, outside the submitted work. Paul Overton is a director of Beacon Medical Communications Ltd, which received funding for this project from UCB Pharma, and additional project funding from UCB Pharma, outside the submitted work. He also received personal fees from Beacon Medical Communications Ltd, during the conduct of the study. Natalie Shalet is a director of NAS HealthCare solutions Ltd, which provided consultancy services to UCB Pharma during this project. Fabian Somers is an employee of UCB Pharma. The authors report no other conflicts of interest in this work.