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Alidori S, Subramanian R, Holm R. Patient-Centric Long-Acting Injectable and Implantable Platforms─An Industrial Perspective. Mol Pharm 2024; 21:4238-4258. [PMID: 39160132 PMCID: PMC11372838 DOI: 10.1021/acs.molpharmaceut.4c00665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
The increasing focus on patient centricity in the pharmaceutical industry over the past decade and the changing healthcare landscape, driven by factors such as increased access to information, social media, and evolving patient demands, has necessitated a shift toward greater connectivity and understanding of patients' unique treatment needs. One pharmaceutical technology that has supported these efforts is long acting injectables (LAIs), which lower the administration frequency for the patient's provided convenience, better compliance, and hence better therapeutical treatment for the patients. Furthermore, patients with conditions like the human immunodeficiency virus and schizophrenia have positively expressed the desire for less frequent dosing, such as that obtained through LAI formulations. In this work, a comprehensive analysis of marketed LAIs across therapeutic classes and technologies is conducted. The analysis demonstrated an increasing number of new LAIs being brought to the market, recently most as aqueous suspensions and one as a solution, but many other technology platforms were applied as well, in particular, polymeric microspheres and in situ forming gels. The analysis across the technologies provided an insight into to the physicochemical properties the compounds had per technology class as well as knowledge of the excipients typically used within the individual formulation technology. The principle behind the formulation technologies was discussed with respect to the release mechanism, manufacturing approaches, and the possibility of defining predictive in vitro release methods to obtain in vitro in vivo correlations with an industrial angle. The gaps in the field are still numerous, including better systematic formulation and manufacturing investigations to get a better understanding of potential innovations, but also development of new polymers could facilitate the development of additional compounds. The biggest and most important gaps, however, seem to be the development of predictive in vitro dissolution methods utilizing pharmacopoeia described equipment to enable their use for product development and later in the product cycle for quality-based purposes.
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Affiliation(s)
- Simone Alidori
- Independent Researcher, Havertown, Pennsylvania 19083, United States
| | - Raju Subramanian
- Gilead Sciences, 333 Lakeside Drive, Foster City, California 94403, United States
| | - René Holm
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Lemu YK, Terfa YB, Inkosa LT, Mohammed AA, Yadeta GB, Tulu YT, Negari DH, Mamo Y, Mamo A. Women's Experiences on Injectable Contraceptive Preference Among Jimma Town Public Health Facilities, Southwest Ethiopia 2023. A Phenomenological Study Design. Open Access J Contracept 2024; 15:1-12. [PMID: 38404542 PMCID: PMC10886205 DOI: 10.2147/oajc.s443453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 02/27/2024] Open
Abstract
Background Contraception is the information, devices, and medications that enable individuals to decide whether and when to have children. It is a cost-effective method of limiting and spacing childbirth. In Ethiopia, the prevalence of modern contraceptives is increasing, and injection contraceptives represent a high prevalence. However, it is unclear why the women preferred injection contraception. Objective To explore Women's experiences on contraceptive preference among Jimma town public health facilities, southwest Ethiopia, 2023. Methods An interpretative phenomenological study design was employed. Women aged between 18 and 49 who have been using injectable contraceptives for more than one year were our study population. Data were collected through in-depth interviews using an open-ended, structured interview guide. The purposive sampling technique was used to select 12 participants from three randomly selected public health facilities in Jimma town. Audio data were transcribed verbatim into word files, and finally, Atlas.ti 7.0 software was used to facilitate coding and categorizing. Results Twelve women who have been using injectable contraceptives for the last year were involved in this study. Religious beliefs, fear of side effects, visiting Arab countries, and previous contraceptive experiences were the main reasons for respondents to prefer injectable contraceptive methods. This study revealed that women were experiencing positive and negative effects while using injection contraceptives. The majority of the respondents felt comfortable and pleased and had not encountered any health-related issues since beginning to use injection contraceptives. Conclusion The key factors influencing respondents' preference for injection methods of contraception included fear of side effects, religious convictions, travel to Arab nations, and prior contraceptive experiences. The majority of respondents felt at ease and pleased and reported no substantial health difficulties associated with injection contraception, despite a few women reporting minor adverse effects. Therefore, switching to long-acting methods of contraception necessitates increased women's understanding of contraceptives.
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Affiliation(s)
- Yohannes Kebede Lemu
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Yonas Biratu Terfa
- School of Nursing, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Ahmed Andiye Mohammed
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Geremu Bayissa Yadeta
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Yidnekachew Tafesse Tulu
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Desalegn Hundera Negari
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Yiftusira Mamo
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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Halpern V, Wheeless A, Brache V, Lendvay A, Cochón L, Taylor D, Dorflinger LJ. A randomized crossover study to evaluate local tolerability following subcutaneous administration of a new depot medroxyprogesterone acetate contraceptive formulation. Contracept X 2023; 5:100100. [PMID: 37823034 PMCID: PMC10562734 DOI: 10.1016/j.conx.2023.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives This study aimed to evaluate and compare local tolerability of investigational drug TV-46046 and reference drug Depo-subQ Provera 104, both containing medroxyprogesterone acetate (MPA) as an active ingredient. Study design We conducted a randomized, crossover, single-center study. Twenty-seven healthy women aged 25 to 47 years at low risk of pregnancy received a subcutaneous injection of each of the four study drugs (120 mg/0.3 mL of TV-46046, 60 mg/0.3 mL of diluted TV-46046, 0.3 mL of TV-46046 placebo, and 104 mg/0.65 mL of Depo-subQ 104) in different quadrants of the abdomen. We assessed local tolerability by occurrence of injection site reactions (ISRs), as well as injection site pain and overall safety for at least 9 months postinjections. Results Of a total of 108 study injections, three injections were partial due to needle blockage. We observed a total of 30 ISRs following 105 full-dose injections, including hypopigmentation (n = 24), bruising (n = 4), and atrophy/dimple (n = 2). Eleven cases of hypopigmentation occurred following 25 full-dose injections of undiluted TV-46046 (44.0%), six following 27 full-dose injections of diluted TV-46046 (22.2%), and seven following 26 full-dose injections of Depo-subQ 104 (26.9%). Hypopigmentations occurred on average 8 months postinjection. Injection pain was minimal and dissipated quickly after all four injections. Conclusions Subcutaneous administration of MPA in a suspension formulation is associated with the delayed onset of hypopigmentation at the site of injection. Although not statistically significant, the rate of ISRs was over 60% higher for undiluted TV-46046 compared to Depo-subQ 104. This difference bears careful monitoring in future studies of TV-46046. Implications From a safety standpoint, investigational drug TV-46046 is appropriate for further clinical testing as a 6-month contraceptive injectable. The previously underreported hypopigmentation associated with subcutaneous administration of MPA warrants further investigation and acceptability assessment among users of existing Depo-subQ 104 as well as careful monitoring of local tolerability of TV-46046 in future clinical trials. Trial registration Registered at clinicaltrials.gov no: NCT02817464.
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Affiliation(s)
| | | | - Vivian Brache
- Profamilia, Biomedical Research Department, Santo Domingo, Dominican Republic
| | | | - Leila Cochón
- Profamilia, Biomedical Research Department, Santo Domingo, Dominican Republic
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Gemmill A, Bradley SEK, Berger BO, Bell SO. The Relationship Between Contraceptive Method Use and Return of Fecundity Among Women Attempting Pregnancy in Low- and Middle-Income Countries. Demography 2023; 60:1163-1179. [PMID: 37449662 PMCID: PMC10529236 DOI: 10.1215/00703370-10877719] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
One of the most common barriers to using effective family planning methods is the belief that hormonal contraceptives and contraceptive devices have adverse effects on future fertility. Recent evidence from high-income settings suggests that some hormonal contraceptive methods are associated with delays in return of fecundity, yet it is unclear if these findings generalize to low- and middle-income populations, especially in regions where the injectable is widely used and pressure to bear children is significant. Using reproductive calendar data pooled across 47 Demographic and Health Surveys, we find that the unadjusted 12-month probability of pregnancy for women attempting pregnancy after discontinuing traditional methods, condoms, the pill, and the IUD ranged from 86% to 91%. The 12-month probability was lowest among those who discontinued injectables and implants, with approximately 1 out of 5 women not becoming pregnant within one year after discontinuation. Results from multivariable analysis showed that compared with users of either periodic abstinence or withdrawal, users of the pill, IUD, injectable, and implant had lower fecundability following discontinuation, with the largest reductions occurring among women who used injectables and implants. These findings indicate that women's concerns about potential short-term reductions in fecundity following contraceptive use are not unfounded.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Blair O Berger
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Compton SD, Manu A, Maya E, Morhe ESK, Dalton VK. Give women what they want: contraceptive discontinuation and method preference in urban Ghana. Contracept Reprod Med 2023; 8:5. [PMID: 36642723 PMCID: PMC9841713 DOI: 10.1186/s40834-022-00200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/11/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Unmet need for contraception remains high in Ghana. Reducing the number of women who discontinue their contraceptive use is one way to decrease the number of women with an unmet need. In this study, we investigated factors associated with discontinuation among a cohort of Ghanaian women. METHODS Women who were beginning a new method of contraception at one of six urban clinics in Accra and Kumasi, Ghana were invited to participate in our study. Participants were interviewed before and after their counseling session, and at 3-, 6-, 9-, and 12-months post-enrollment to determine continuation. During follow-up, participants who were no longer using their method were asked why, if they were using any method of contraception, and if so, which method. Logistic regression analysis was performed to identify factors associated with discontinuation for reason other than pregnancy or desired pregnancy. RESULTS Of the 472 women who reported leaving their counseling session with a method, 440 (93.2%) had at least one follow-up contact. Of the 440 women, 110 (25%) discontinued their method at some point over the 12-month period, and 94 (85.5%) did so for reasons other than pregnancy or desired pregnancy. In the multivariate regression analysis, women who reported they were given their method of choice were 12.0% less likely to discontinue due to a non-pregnancy reason (p=0.005); those who used a long-acting reversible contraceptive (LARC) method were 11.1% less likely (p=.001); and those who reported they would choose to use that method again, one measure of satisfaction, were 23.4% less likely (p<.001). CONCLUSIONS To our knowledge, the current study is the first to explore method preference and its relation to continuation. Women in our study who reported they were given the contraceptive method of their choice were less likely to discontinue using that method for non-pregnancy-related reasons. Further, those who adopted a LARC method and those who reported they would make the same method choice again were less likely to discontinue. Women should be supported in selecting a contraceptive method of their choice. Providers should work with their clients to find a method which meets their preferences.
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Affiliation(s)
- Sarah D. Compton
- grid.214458.e0000000086837370University of Michigan Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Adom Manu
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Ernest Maya
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Emmanuel S. K. Morhe
- grid.449729.50000 0004 7707 5975University of Health and Allied Sciences Department of Obstetrics and Gynaecology, PMB 31, Ho, Volta Region Ghana
| | - Vanessa K. Dalton
- grid.214458.e0000000086837370University of Michigan Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
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Keogh SC, Otupiri E, Castillo PW, Chiu DW, Polis CB, Nakua EK, Bell SO. Hormonal contraceptive use in Ghana: The role of method attributes and side effects in method choice and continuation. Contraception 2021; 104:235-245. [PMID: 33992609 DOI: 10.1016/j.contraception.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To understand the barriers and facilitators of hormonal contraceptive use among Ghanaian women, in order to help improve contraceptive counseling and reduce the high rates of unintended pregnancy. STUDY DESIGN We conducted a nationally representative community-based survey of 4143 women aged 15-49 in 2018, and used descriptive statistics and logistic regression to examine correlates of current hormonal method use, preferred method attributes and their association with method choice, and the role of side effects in hormonal method discontinuation. RESULTS Hormonal method use (vs. contraceptive non-use) was associated with younger age, higher parity and education, but not with union status, wealth or residence. Preferences for key method attributes were associated with choosing particular methods. Most valued attributes were effectiveness at preventing pregnancy, and low risks of harming health and future fertility. These last 2 concerns are echoed in the second most common reason for discontinuation (health concerns). While menstrual changes were a common concern, leading some respondents to discontinue hormonal contraceptives, many were willing to endure these effects. In contrast, having experienced long-term health issues as a perceived result of hormonal method use more than halved the odds of current use. Contraceptive counseling on menstrual changes, other side effects, and impacts on future fertility had not been universally provided. CONCLUSIONS Ghanaian women value hormonal methods for their effectiveness against pregnancy. However, concerns about side effects (particularly bleeding changes), future fertility impairment, and long-term health issues led some women to discontinue hormonal methods. Counseling on these issues was reportedly inadequate. IMPLICATIONS Identifying barriers to, and facilitators of, hormonal contraceptive use, as well as method attributes important to Ghanaian women, can help to better tailor contraceptive counseling to individual needs, in order to ensure that all women can access the method that suits them best, and decide whether and how to manage side effects, switch methods or discontinue.
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Affiliation(s)
| | - Easmon Otupiri
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | - Doris W Chiu
- Guttmacher Institute, New York, NY, United States.
| | - Chelsea B Polis
- Guttmacher Institute, New York, NY, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Emmanuel K Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Ahuja M, Frimpong E, Okoro J, Wani R, Armel S. Risk and protective factors for intention of contraception use among women in Ghana. Health Psychol Open 2020; 7:2055102920975975. [PMID: 33329897 PMCID: PMC7720324 DOI: 10.1177/2055102920975975] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The use of various forms of contraception in Ghana gained prominence after the government resorted to investing more in family planning programs when maternal mortality was declared an emergency in the country. In Ghana, the intention to use and actual usage of contraceptives is influenced by many factors, which may lead to non-usage or discontinuation. This quantitative study was conducted to determine risk and protective factors impacting on the intention and usage of contraceptives. Survey data from the Ghana 2014 Demographic and Health Survey (DHS) (n = 9396) was used. A sub-sample of 7661 women in their reproductive age were included in this study, who reported being sexually active within the last year. Logistic regression analyses were conducted to test the association between a broad range of risk and protective factors including religion, early sexual intercourse, frequency of sex, number of lifetime sexual partners with intention to use contraception. We controlled for income, educational attainment, and age. Overall (n = 3661; 47.8%) reported no intention of contraception use. Logistic regression analysis revealed that no formal education (OR = 1.49; 95% CI, 1.29–1.72; p < 0.001), and primary school as highest educational level (OR = 1.19; 95% CI, 1.04–1.25; p < 0.001), Islamic religion (OR = 0.73; 95% CI, 0.59–0.90; p < 0.001), not currently employed (OR = 1.50; 95% CI, 1.34–1.69; p < 0.001), husband opposing contraception use (OR = 2.19; 95% CI, 1.42–3.46; p < 0.001), and currently pregnant (OR = 1.30; 95% CI, 1.09–1.54; p < 0.001) were also positively associated with no intention of use. Engaging religious leaders for advocacy in the community was identified as an approach to address barriers and increase awareness on contraceptive use. Targeted family planning programs should intensify public education on safe sex behaviors.
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Affiliation(s)
| | | | - Joy Okoro
- East Tennessee State University, USA
| | - Rajvi Wani
- University of Nebraska Medical Center, USA
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Odwe G, Gray K, Kyarimpa A, Obare F, Nagendi G. Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) Injectable Contraception at Facility and Community Levels: Pilot Results From 4 Districts of Uganda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:711-722. [PMID: 30429201 PMCID: PMC6370348 DOI: 10.9745/ghsp-d-18-00117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022]
Abstract
Over 1 year, the NGO-led project provided more than 14,000 units of DMPA-SC, mostly in community settings and to a substantial proportion (43%) of young women. The share of injectables increased significantly, as did the volume of all methods provided, including short-acting, long-acting, and permanent methods. Reproductive Health Uganda (RHU), a local NGO, introduced subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana Press) in 4 districts of Uganda between April 2016 and March 2017. RHU trained public and private facility providers on all family planning methods including DMPA-SC; trained community health workers (known as village health teams, VHTs) to give family planning counseling, provide short-acting methods including DMPA-SC, and make referrals for long-acting and permanent methods; conducted mobile outreach and raised awareness of family planning; and provided family planning commodities. We used a retrospective cross-sectional evaluation design drawing on data from (1) in-depth interviews with 32 facility- and community-based providers; (2) key informant interviews with 7 policy makers and program staff; and (3) family planning program statistics from 4 RHU clinics, 26 mobile outreach sites, and 40 VHTs in 4 study districts. Data collection took place between April and June 2017. Over 12 months, 14,273 units of DMPA-SC were provided in RHU clinics, by mobile outreach teams, and by VHTs. DMPA-SC units were mostly administered in community settings either by VHTs (70%) or at mobile outreach events (26%). A substantial proportion (43%) of DMPA-SC units were administered to young people (<25 years), a significantly higher proportion compared with other methods provided to this age group through the project (P<.001), except condoms. In addition, a greater proportion of DMPA-SC units provided at the community level by VHTs were used by young people (45%) compared with units provided at outreach (36%) or in clinics (35%). Overall, injectables (DMPA-SC and intramuscular DMPA combined) came to represent 43% of all contraceptive methods provided, up from a baseline of 20%. This shift occurred despite significant increases in the volume of all other methods provided (P<.001). Qualitative data revealed various factors that facilitated introduction, including comprehensive training, commodity availability, strong referral links, and early community engagement. RHU's experience supports the viability of community-based delivery of DMPA-SC and identifies opportunities to strengthen this approach. There is further evidence that DMPA-SC may be popular with young people, especially in community settings.
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Affiliation(s)
| | - Kate Gray
- International Planned Parenthood Federation, London, United Kingdom
| | | | | | - Grace Nagendi
- International Planned Parenthood Federation, Africa Region, Nairobi, Kenya
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