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Case Study 1

ExtaviPro® 30G – A solution to low adherence in Multiple Sclerosis (MS) treatment

The Owen Mumford Challenge

Multiple Sclerosis (MS) is a chronic debilitating inflammatory disease of the central nervous system and currently affects 2.5 million people worldwide. Patients often have to live with symptoms like blurred vision, cognitive impairment, and poor co-ordination. Presently there is no curative treatment; instead there are several disease-modifying therapies (DMTs) that aim to control the disease course, like preventing relapse, and slowing disease as well as disability progression.1

Due to MS’s chronic nature, people may live with the disease for several decades.2 One particular treatment (interferon beta-1b) has shown some impressive results by reducing all-cause mortality by 47% at 21 years in patients who received the treatment within their first two years of therapy, when compared with placebo.3 But despite the benefits of this promising form of MS therapy, it still faces one major issue – adherence.

Poor patient adherence to interferon beta-1b is often the result of adverse events relating to injectable therapies, like anxiety of injecting,1 injection site pain (ISP) and injection site reactions (ISRs). ISP and ISRs occur more often if patients inject into the skin rather than the muscle, and because interferon beta-1b is injected into the skin this can greatly affect how patients adhere to their treatment schedule. MS patients have to follow their treatment protocol to prevent relapse, and not adhering could be putting their health at risk.3

2.5m people worldwide are currently affected by MS

The Analysis

We created an original injection device for Extavia®, an interferon beta-1b from Novartis, based on our clinically robust and successful auto-injector platform: the Autoject2®. This platform not only helps minimise ISP and ISRs, but also makes injecting easier and reduces patient anxiety. We wanted to further explore refinements that could be made specifically for MS patients and the only way to do this was to ask the patients themselves. Not surprisingly, they rated convenience and ease of use as the most important factors for an auto-injector. This feedback led to the development of the new device, which is still based on the Autoject2® platformtechnology, but is further refined for MS patients®.

Engineering Design

The new device, called ExtaviPro® 30G, is more ergonomically designed, assisting one-handed use and enhancing patient confidence when injecting.4 As needle diameter is associated with greater ISP and ISRs, the ExtaviPro® 30G retains the use of the thinnest needle in the market – 30 gauge (30G).3,5 Constant force spring technology was also incorporated to enhance ease of use. But despite all our prior research we were still missing one crucial element that could either make or break our product: how did the new ExtaviPro® 30G compare to its competitors, and more crucially what did patients think?

Patient Responses

When comparing the ExtaviPro® 30G with a competitor device, 86% of patients said they preferred the ExtaviPro® 30G. The most common reasons for this preference was the ergonomic shape of the device, easy operation, reach and being able to inject one-handed. Other attributes the ExtaviPro® 30G outperformed on were intuitive use and ability to read the display. All these attributes are associated with convenience, which is an important factor that increases adherence and can shift patient preference from one auto-injector to another.4

Our Insights

It appears the problem of low adherence can be minimised, if we listen to patients and design devices that not only push boundaries in terms of their technology, but keep in mind the patients’ needs. The ExtaviPro® 30G has been shown to solve some aspects of low adherence, and as a result increases drug administration. With greater adherence there are not only better health outcomes for patients, but also better revenue outcomes for pharmaceutical companies. If consumption can be increased, adherence can be improved, which in turn increases both prescribing and generation of revenue.

 

The devices described in this case study belong to companies which are not Owen Mumford.

References:

  1. Menzin J, Caon C, Nichols C, White L, Friedman M, Pill MW. Narrative Review of the Literature on Adherence to Disease-Modifying Therapies among Patients with Multiple Sclerosis. Supplement to JMCP 2013; 19(1-a):S24-33
  2. DH Long-term Conditions NSF Team. The National Service Framework for Long-term Conditions. Gateway Reference 4377, 2005
  3. Boeru G et al. ExtaviJect®30G device for subcutaneous self-injection of interferon beta 1-b for multiple sclerosis: a prospective European study. Medical Devices: Evidence and Research. 2013; 6: 175-184
  4. Thakur K, Manuel L, Tomlinson M. Autoinjectors for administration of interferon beta-1b in multiple sclerosis: patient preferences and the ExtaviPro™30G and Betacomfort® devices Pragmatic and Observational Research. 2013; 4: 19-26
  5. Kozubski W. Autoinjector Improves Injection-related Tolerability Issues in Patients with Muliple Sclerosis – Exploring the New ExtaviJect™ 30G system for the injection of Interferon Beta-1b. European Neurological Review. 2010; 5(2):77-81