assessing the tolerability of 5 and 15 second injections of 2 ml into different injection sites
TRANSCRIPT
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Assessing the tolerability of 5 and 15 second injections of 2 ml into different injection sites
Chris Muenzer, Senior Device Engineer, Roche
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The purpose of this presentation is to share our experience and learnings with 2 ml injections
Clinical Plan
Device Solution
Results
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New autoinjectors are being developed which can deliver up to 2 ml
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But how fast should an autoinjector inject 2 ml?
Not Tolerated Hard to Use
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We developed a clinical plan to look at the speed of injection
Active DP / Abdomen
5 sec
holdPlacebo / Abdomen
Placebo / Thigh
no hold Placebo / Abdomen
Placebo / Thigh
15 sec
holdPlacebo / Abdomen
Placebo / Thigh
no holdPlacebo / Abdomen
Placebo / Thigh
48 Total Subjects
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• Pain (VAS) – Primary End Point
• Local Site Assessment
• Delivered Volume
• Injection Site Leakage
• Pharmacokinetics (PK)
The study evaluated a range of clinical endpoints
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Infusion pumps could be used to deliver 2 ml…
OCCLUSION ALARMS!
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A Harvard Pump would be capable….
NOT FOR HUMAN USE!
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Or we could build two autoinjectors with two different speeds
TOO COMPLEX!
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Manual injection was the only option
Flange to assist with injection force
Spacer to set the needle depth and angle
Foot to mimic contact of autoinjector
Timing reference to control the injection speed
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3D printed devices were manufactured for the study
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An example of the delivery method
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Pain is measured on a 100 mm scale, anchored by word descriptors
22 mm
The patient marks on the line the point that they feel represents their perception of their current state. The VAS score is determined by measuring in millimeters from the left hand end of the line to the point that the patient marks.
D. Gould et al. Visual Analogue Scale (VAS). Journal of Clinical Nursing 2001; 10:697-706
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Preliminary statistical analysis showed that a 15 second injection time is less painful
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…but was unable to conclude that there is a difference due to injection site or content
11 5 19 4 4 2
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The pain is within the range observed with marketed drugs
Median pain for 15 second injection into the abdomen
Median pain for 5 second injection into the abdomen
X
First Quartile Third Quartile
Median Mean
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PK profiles were considered equivalent for both injection speeds and with or without a 5 second hold after injection
Time (hrs)
Pla
sma
Co
nce
ntr
atio
ns
15 secw/ holdw/o hold
5 secw/ holdw/o hold
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Site leakage was evaluated using two different measurements
Visual AssessmentFluid Measurement
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Fluid measurement showed very small amount of leakage (less than 0.01 ml) for most subjects
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Visual assessments could not show statistical differences in the percentage of subjects with injection site leakage or blood
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2D ultrasound showed exclusive SC localization and equivalent size for both speeds
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• Simple low cost solution was developed to meet the needs of
the study
• SC injection of 2 mL into the abdomen is well tolerated with
less pain associated with 15 second injection compared to 5
second injection.
• The pain following 5 or 15 second administration is within the
range observed with marketed drugs.
Conclusions
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Roche Team
Agnes Portron
Carsten Hofmann
Neil Cammish
Jörg Sielemann
With Support From
Technical Development Team
Isabelle Bauer Dauphin
Pierre Goldbach
Christelle Laroche
pRED Lab Technologies and Robotics
Thomas Zumstein
Tom Kissling
Product Development Global Operations
Emma Lindley
Jenny Tovey
Kristy Draper
PRA Lenexa, Kansas
Brandi Cadue
Daniel Dickerson
Jeffrey Hinchey
Amanda Barber
Acknowledgements
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Questions?