Patients’ and nurses’ preferences for autoinjectors for rheumatoid arthritis: results of a European survey

Figures & data

Table 1 Demographic characteristics of patient sample (adults with moderate–severe RA) with breakdown by currently used autoinjector (n=200)

		Currently used autoinjector
		Molly^® for etanercept (Benepali), n=54	MyClic^® for etanercept (Enbrel), n=70	Humira^® pen for adalimumab (Humira), n=76
Sex
Female	64%	61%	64%	66%
Male	36%	39%	36%	34%
Age
Average	52 years	55 years	51 years	50 years
≤30 years	2%	0	1%	4%
31–40 years	12%	6%	17%	11%
41–50 years	29%	24%	29%	32%
51–60 years	36%	41%	33%	34%
61–69 years	23%	30%	20%	20%
Highest level of education
Primary school	2%	2%	0	3%
Secondary school	29%	31%	27%	28%
High school	36%	39%	33%	36%
University	35%	28%	40%	34%
Duration of use
Average	27 months	7 months	32 monthsa	37 monthsa
≤12 months	47%	89%b,c	34%	29%
13–36 months	34%	11%	47%a	38%a
>36 months	19%	0	19%a	33%a
Country
France	18%	11%	21%	20%
Germany	23%	28%	21%	20%
Italy	23%	28%	21%	20%
Spain	14%	6%	11%	21%a,b
UK	24%	28%	24%	20%

Notes:

a Significantly higher than Benepali (P<0.01);

b significantly higher than Enbrel (P<0.01);

c significantly higher than Humira (P<0.01). Two-tailed significance tests.

Abbreviation: RA, rheumatoid arthritis.

Figure 1 Patient and nurse ratings of importance of attributes of an autoinjector.

Notes: *Nurse rating was significantly higher than that of patients (P<0.01). Arithmetic means on a scale of 1–10 (1, not important at all; 10, extremely important).

Table 2 Correlations between importance of ease of performance of self-injection with pen and importance of other autoinjector features

	Patients n=200	Nurses n=100
	Pearson’s r
Easy to grip the pen	0.54a	0.25b
Intuitive to use/self-explanatory	0.46a	0.42a
Visual feedback after completion of injection (one can see when injection is completed)	0.42a	0.18
Right size of the pen (neither too small nor too large)	0.41a	0.22b
Audible feedback after completion of the injection (eg, a click telling when injection completed)	0.33a	0.27a
Injection needle safely concealed in injector body	0.29a	0.10
Convenient starting of injection without pushing a button	0.22a	−0.03
Weight of pen	0.19a	−0.01
Convenient starting of injection by pushing a button	0.19a	0.18
Convenient shape of pen	0.18b	0.07

Notes:

a P<0.01 (two-tailed);

b P<0.05 (two-tailed).

Figure 2 Patient satisfaction with the four autoinjectors.

Notes: Satisfaction shown as percentage of patients rating each injection device excellent or very good (based on a verbal 5-point scale: excellent, very good, good, moderate, poor). ^Esignificantly higher than MyClic (P<0.01; shape of pen, P<0.05); ^Hsignificantly higher than Humira pen (P<0.01); ^Ssignificantly higher than SensoReady (P<0.05). Molly and SensoReady compared with MyClic and Humira pen using one-tailed significance tests. Other comparisons performed using two-tailed tests.
Abbreviation: NA, not applicable.

Figure 3 Nurse satisfaction with the four autoinjectors.

Notes: Satisfaction shown as percentage of nurses rating each injection device excellent or very good (based on a verbal 5-point scale: excellent, very good, good, moderate, poor). ^B*Significantly higher than Molly (P<0.05); ^B**significantly higher than Molly (P<0.01); ^E*significantly higher than MyClic (P<0.05); ^E**significantly higher than MyClic (P<0.01); ^H*significantly higher than Humira pen (P<0.05); ^H**significantly higher than Humira pen (P<0.01). Molly and SensoReady compared with MyClic and Humira pen using one-tailed significance tests. Other comparisons performed using two-tailed tests.
Abbreviation: NA, not applicable.

Figure 4 Overall rating of SensoReady after presentation and simulation of use of injection device.

Figure 5 Direct comparison of SensoReady with the autoinjector currently used by the patients.

Notes: *SensoReady selected significantly more often than the comparator (P<0.05; one-tailed binomial tests); **SensoReady selected significantly more often than the comparator (P<0.001).

Figure 6 Forced-choice selection of autoinjector perceived to be easier to use.

Notes: Pairwise comparisons between SensoReady autoinjector and autoinjectors currently used by patients and nurses. *SensoReady selected significantly more often than comparator (P<0.05; one-tailed binomial tests); **SensoReady selected significantly more often than comparator (P<0.001).

Figure 7 Forced-choice selection of autoinjector to recommend to other patients.

Notes: Pairwise comparisons between SensoReady and autoinjectors currently used by patients. **SensoReady selected significantly more often than comparator (P<0.001).

Table 3 Features of autoinjectors investigated in this survey

	SensoReady^® for etanercept (Erelzi^®)	Molly^® for etanercept (Benepali^®)	MyClic^® for etanercept (Enbrel^®)	Humira^® pen for adalimumab
Length	166 mm	142 mm	158 mm	187 mm
Diameter	20 mm	17 mm	18 mm	20 mm
Weight (empty without active ingredient)	42 g	26 g	27 g	34 g
Shape	Triangular with rounded angles	Round	Round	Round
Caps to be removed before injection	One (at needle)	One (at needle)	One (at needle)	Two (one at needle + one at release button)
Starting the injection	Without button	Without button	With button	With button
First click indicating start of injection	✓	✓	✓	✓
Second click indicating end of injection	✓	✓	✓	No
Size of window for visual feedback (indicator that full dose had been injected)	One window (360°) 32×20 mm	Two windows 32×5 mm	Two windows 32×5 mm	Two windows 26×5 mm