Prefilled Pens, Fewer Injections Improve Satisfaction in Psoriasis Patients with Needle Phobia

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A new study revealed user-friendly devices, such as prefilled pens, and a lower number of injections improve satisfaction in patients with psoriasis who have trypanophobia, otherwise known as “needle phobia.”¹

“This study indicates how even patients with severe needle phobia, who were previously more likely to face a loss of drug efficacy due to reduced adherence, can benefit from a pen device,” wrote investigators, led by Alexandra Maria Giovanna Brunasso, from Unit of Dermatology at Villa Scassi Hospital in Italy.

Trypanophobia may stand in the way of patients achieving effective management of chronic diseases when the treatment involves injections—and psoriasis is one of those diseases. Although psoriasis can be treated with oral and topical medications, it can effectively be treated with biological drugs administered subcutaneously.^2,3

Luckily for people who hate needles, anti-IL-23 drugs only require a few injections each year and are available in prefilled pens that hide the needle.¹ Therefore, this serves as a good treatment option for patients with trypanophobia.

Investigators conducted an observational multicentric study on 22 patients with moderate-to-severe psoriasis who were treated with 75 mg x 2 risankizumab prefilled syringe therapy for > 6 months but reported a loss of efficacy measured by the Psoriasis Area and Severity (index) from PASI 90 to PASI 75. The loss of efficacy was attributed to a reduced adherence due to trypanophobia.

The sample included 12 males and 10 females, and the average age was 63 years. Participants had an average disease duration of 19.7 years and a mean duration of systematic therapy of 7.4 years.

Among the sample, 10 patients had previous experience with biologics other than risankizumab. Moreover, 6 patients had a history of depression.

Patients were switched to 1 prefilled pen of risankizumab 150 mg and asked to fill out the Self-Injection Assessment Questionnaire before and 12 weeks after the injection. Participants scored each item on the SIAQ on a 5-point scale; the score ranged from 0 (worst experience) to 10 (best experience).

Before their first injection, the mean SIAQ domain scores were 5.5 for feelings about the injection, 6.2 for self-confidence, and 6.4 for satisfaction with self-injection. After dosing, scores were greater (> 8.5) for all the domains at week 0. Scores were even greater after 12 weeks (> 9.0).

Among the sample, 90.9% of participants at week 0 and 95.5% at week 12 reported the self-injection device was “easy” or “very easy.” Likewise, 90.9% and 95.5% of participants found it “easy” or “very easy” to self-administer the injection at week 0 and week 12, respectively.

Moreover, 95.5% and 86.4% reported it being “very easy” or “extremely easy” to self-administer an injection at week 0 and week 12, respectively. Overall, 90.9% of participants were “satisfied” or “very satisfied” with the self-injection.

When assessing the relationship between a patient’s duration of systematic therapy and disease duration with their SIAQ scores, investigators found patients on systematic therapy for > 7 years had lower SIAQ pre-injection domain scores. Patients with a disease duration of > 19 years had greater pre-dose domain scores. However, both relationships were not statistically significant (P > .05).

Furthermore, patients with depressive symptoms had lower SIAQ pre-dose domain scores than the mean values but the difference was not significant in the post-SIAQ scores (P > .05).

Investigators wrote the findings were limited by the small sample size and no control group.

“This study provides fascinating insights. It reveals that the loss of effectiveness of a therapy may not be caused by the drug itself, but rather by patients' fear of needles, which leads to the avoidance of administration,” investigators concluded. “Understanding this could enable us to make some changes to our strategies to improve adherence.

References

1. ^{Brunasso AMG, Salvi I, Sorbara S, et al. Improvement of self-administration experience with a new injection device: Real-life experience with risankizumab in patients with psoriasis. Skin Res Technol. 2024;30(8):e13902. doi:10.1111/srt.13902}
2. ^{Pine, L. Tapinarof Cream 1% Rapidly Improves Mild to Severe Plaque Psoriasis. HCPLive. October 23, 2023. https://www.hcplive.com/view/tapinarof-cream-1-rapidly-improves-mild-to-severe-plaque-psoriasis. Accessed August 28, 2024.}
3. ^{Miller, L at Jayme, H. Advances in Oral Therapies in Plaque Psoriasis. HCPLive. October 6, 2023. https://www.hcplive.com/view/advances-in-oral-therapies-in-plaque-psoriasis. Accessed August 28, 2024.}