Understanding and Minimising Injection-Site Pain Following Subcutaneous Administration of Biologics: A Narrative Review
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REVIEW
Understanding and Minimising Injection-Site Pain Following Subcutaneous Administration of Biologics: A Narrative Review Anja St Clair-Jones . Francesca Prignano . Joao Goncalves . Muriel Paul . Philipp Sewerin
Received: September 9, 2020 / Accepted: October 3, 2020 The Author(s) 2020
ABSTRACT Injection-site pain (ISP) is a subjective side effect that is commonly reported with the subcutaneous administration of biological agents, yet it may only be a concern to some. Multiple factors related to the product formulation, such as pH, volume and excipients, and/or to the injection process have the potential to contribute to ISP, while patient-related factors, such as low body weight, gender and age, can make an individual A. St Clair-Jones (&) Pharmacy Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK e-mail: [email protected] F. Prignano Section of Dermatology, Department of Health Science, University of Florence, Florence, Italy J. Goncalves iMed-Research Institute for Medicines, Faculdade de Farma´cia, Universidade de Lisboa, Lisbon, Portugal M. Paul Department of Pharmacy, AP-HP, Henri-Mondor Hospital, Cre´teil, France M. Paul University of Paris-Est Cre´teil, Epidemiology in Dermatology and Evaluation of Therapeutics (EpidermE), EA 7379, UPEC, Cre´teil 94010, France P. Sewerin Department and Hiller Research Unit of ¨ sseldorf (UKD), Rheumatology, University Clinic Du ¨ sseldorf, Germany Heinrich Heine University, Du
more susceptible to experiencing ISP. While total elimination of ISP remains unlikely with any subcutaneously administered agent, it can be minimised by helping the patient to develop a confident and competent injection technique via robust and effective training. Careful management of patient expectations along with open discussion regarding the potential risk of ISP may serve to minimise treatment-related anxieties and, importantly, allow the patient to remain in control of his/her treatment. Other interventions to help minimise ISP include psychological interventions, allowing biologics to reach room temperature prior to injection, using the most suitable injection device for the individual patient and selecting an alternative drug formulation, when available. Productive patient–physician communication remains important in order to support and optimise treatment experience and adherence, while also providing the opportunity for patients to discuss any ISP-related issues.
Keywords: Biosimilar; Formulation; Injection process; Injection-site pain; Patient–physician communication; Subcutaneous; Training
Rheumatol Ther
INTRODUCTION Key Summary Points Injection-site pain (ISP) is a commonly reported subjective side effect with the subcutaneous (SC) administration of biological agents, yet it may only be a concern to some. Multiple factors, including those related to product formulation (e.g. pH, volume, excipients, injection process) and to the patient (low body weight, gender and age) have the potential to contribute to ISP. While total elimination of
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