Development of the SoloSTAR®insulin pen device: design verification and validation

User-Centric Approach to Specifying Technical Attributes of Drug Delivery Devices: Empirical Study of Autoinjector-Cap Removal Forces

PURPOSE

The subcutaneous delivery of biologics using pre-filled autoinjector devices continues to attract broad scholarly interests. However, research still lacks a detailed understanding of user perceptions as the basis for specifying the clinically relevant technical attributes of a device, such as the cap-removal force. Therefore, this article studies the ability of users to remove the autoinjector cap, as well as the effects of the cap-removal force and user characteristics on the perceived ease of decapping.

PATIENTS AND METHODS

Forty-two participants among patients, caregivers, and healthcare professionals removed the protective cap using non-functional devices with different target cap-removal forces between 25 N and 55 N. Data were collected on the ability of the users to effectively decap the device and their perceived ease of decapping. Linear regression was then applied to quantify the impact of the decapping force and patient characteristics on the perceived ease of decapping.

RESULTS

The participants of the study effectively decapped all autoinjector devices irrespective of age, sex, and dexterity impairments. Moreover, the study reveals that the perceived ease of decapping decreases significantly with increasing decapping force and participants' dexterity impairments.

CONCLUSION

The study provides initial empirical evidence on the ability of users to decap autoinjector devices and shows how increasing the cap-removal force and dexterity impairments reduce the perceived ease of decapping.

How to prevent medication errors: a multidimensional scaling study to investigate the distinguishability between self-injection platform device variants

Background: The importance of subcutaneous drug delivery using self-injection devices based on common device platforms continues to grow. The resulting broad adoption of potentially look-alike or similar devices, however, raises concerns over limited device distinguishability and ensuing risk of medication errors. The objective of the study is thus to understand whether and how users effectively distinguish between self-injection device variants. Methods: Seventy-four patients, caregivers, and healthcare professionals were asked to pairwise rate the similarity of eight platform autoinjector variants. Multidimensional scaling was then used to convert individual ratings into spatial configurations and thereby identify the attributes that influence device distinguishability. Results: Five different device attributes driving distinguishability were identified. Three of the attributes corresponded to single design features (the label color, device size and device shape). Two device attributes (the aspect ratio and chromaticity) combined distinct yet interrelated design features. Conclusions: The study provides initial empirical evidence that users are able to distinguish between device variants and as to what device attributes drive distinguishability. Furthermore, the results highlight patterns in how various user groups distinguish between device variants. These patterns relate with the user group characteristics (e.g. age, sight or dexterity) and the context of device usage (e.g. healthcare professionals).

Biosimilar insulins: guidance for data interpretation by clinicians and users

Biosimilar insulins are approved copies of insulins outside patent protection. Advantages may include greater market competition and potential cost reduction, but clinicians and users lack a clear perspective on 'biosimilarity' for insulins. The manufacturing processes for biosimilar insulins are manufacturer-specific and, although these are reviewed by regulators there are few public data available to allow independent assessment or review of issues such as intrinsic quality or batch-to-batch variation. Preclinical measures used to assess biosimilarity, such as tissue and cellular studies of metabolic activity, physico-chemical stability and animal studies of pharmacodynamics, pharmacokinetics and immunogenicity may be insufficiently sensitive to differences, and are often not formally published. Pharmacokinetic and pharmacodynamic studies (glucose clamps) with humans, although core assessments, have problems of precision which are relevant for accurate insulin dosing. Studies that assess clinical efficacy and safety and device compatibility are limited by current outcome measures, such as glycated haemoblobin levels and hypoglycaemia, which are insensitive to differences between insulins. To address these issues, we suggest that all comparative data are put in the public domain, and that systematic clinical studies are performed to address batch-to-batch variability, delivery devices, interchangeability in practice and long-term efficacy and safety. Despite these challenges biosimilar insulins are a welcome addition to diabetes therapy and, with a transparent approach, should provide useful benefit to insulin users.

Dose accuracy and injection force of different insulin glargine pens

BACKGROUND

Dose accuracy and injection force, representing key parameters of insulin pens, were determined for three pens delivering insulin glargine-based copies, Pen Royale (WR) and DispoPen (WD) for Glaritus® (Wockhardt) and GanLee Pen (GL) for Basalin® (Gan & Lee), compared with pens of the originator, ClikSTAR® (CS) and SoloSTAR® (SS) for Lantus® (Sanofi).

METHODS

Using the weighing procedure recommended by DIN EN ISO 11608-1:2000, dose accuracy was evaluated based on nonrandomized delivery of low (5 U), mid (30 U), and high (60 U) dosage levels. Injection force was measured by dispensing the maximum dose of insulin (60 U for the GL, WR, and WD; 80 U for the SS and CS) at dose speeds of 6 and 10 U/s.

RESULTS

All tested pens delivered comparable average doses within the DIN EN ISO 11608-1:2000 limits at all dosage levels. The GL revealed a higher coefficient of variation (CV) at 5 U, and the WR and WD had higher CVs at all dosage levels compared with the CS and SS. Injection force was higher for the WR, WD, and GL compared with the CS and SS at both dose speeds. In contrast to the CS and SS with an end-of-content feature, doses exceeding the remaining insulin could be dialed with the WR, GL, and WD and, apparently, dispensed with the WD.

CONCLUSIONS

All pens fulfilled the dose accuracy requirements defined by DIN EN ISO 11608-1:2000 standards at all three dosage levels, with the WR, WD, and GL showing higher dosage variability and injection force compared with the SS and CS. Thus, the devices that deliver insulin glargine copies show different performance characteristics compared with the originator.

Injection force of reusable insulin pens: Novopen 4, Lilly Luxura, Berlipen, and ClikSTAR

BACKGROUND

Insulin pen devices are used by approximately half of insulin users worldwide. The injection force of insulin pens is a key element in their design. This study aimed to demonstrate that the sanofi-aventis reusable ClikSTAR® (CS) pen has an improved injection force over existing insulin pens.

METHODS

The injection force of four reusable insulin pens--Novopen® 4 (NP4; Novo Nordisk), Luxura® (LL; Eli Lilly and Co.), Berlipen® (BP; Haselmeier GmbH), and CS (sanofi-aventis)--was tested in a laboratory setting. Injection force was tested using two methods: six dispense rates between 6 and 24.66 U/s (constant volume flow rate) and constant button speeds of 4 and 8 mm/s.

RESULTS

The CS required a lower mean injection force versus NP4, LL, and BP at both doses and all dispense rates. Mean injection force was 45%, 126%, and 60% higher for NP4, LL, and BP versus CS, respectively (p < .05 for each of the comparisons), for a flow rate of 6 U/s at 60 U dose. Mean injection force in all pens increased with the dispense rate, but the injection force remained significantly lower for CS versus all other pens (p < .05). The injection force for CS was significantly lower for 60 U at 10 and 17.03 U/s than for 80 U.

CONCLUSIONS

The study demonstrated that CS pens require a lower injection force at a wide range of different injection speeds than other reusable insulin pens. This is an important benefit for patients with diabetes, especially those with limited dexterity.

Do different body colors and labels of insulin pens enhance a patient's ability to correctly identify pens for injecting long-acting versus short-acting insulins?

BACKGROUND

The objective of this study was to characterize how successfully patients with diabetes are able to distinguish between pens of the same pen type containing long- and short-acting insulins.

METHODS

Structured one-on-one interviews were conducted with 400 patients with diabetes in the United States, using either a differentiated (n = 100) or undifferentiated (n = 100) SoloSTAR® (insulin glargine vs insulin glulisine) or (n = 200) FlexPen® (insulin detemir vs insulin aspart). A pair of each pen type was presented simultaneously, and participants were asked to identify the pen that they would use to (1) inject at lunch, (2) inject once daily, and (3) inject at breakfast and how they differentiated between pens. The short-acting insulin pen was then presented, and the interviewer asked whether this was the correct pen to administer insulin once or thrice daily.

RESULTS

More patients successfully identified the correct SoloSTAR pen across the tests vs FlexPen, and the error rate (incorrect selection/inability to select) was significantly lower, respectively [2.7% (n = 8) vs 16.3% (n = 98)]. The most common reason cited for correct responses among all patients was color (of the label/pen, according to pen type).

CONCLUSIONS

This study suggests that the full pen body color used on SoloSTAR pens enhances the patient's ability to differentiate between the pens for long- and short-acting insulin and is a notable improvement compared with the standard approach of differing label color.

An evaluation of prefilled insulin pens: a focus on the Next Generation FlexPen(®)

Insulin pen delivery systems are preferred by patients over the traditional vial and syringe method for insulin delivery because they are simple and easy to use, improve confidence in dosing insulin, and have less interference with activities and improved discretion with use. Insulin manufacturers have made numerous improvements to their first marketed pen devices and are now introducing their next generation of devices. Design modifications to the newest generation of prefilled insulin pen devices are intended to improve the ease of use and safety and continue to positively impact adherence to insulin. This review focuses on the Next Generation FlexPen(®) with regard to design considerations to reduce injection force, improve accuracy and ease of use, and evaluate the preference of patient and health-care provider compared with other disposable, prefilled insulin pen devices.

Reusable and disposable insulin pens for the treatment of diabetes: understanding the global differences in user preference and an evaluation of inpatient insulin pen use

Insulin is essential for the management of type 1 diabetes and is more commonly being used for the treatment of type 2 diabetes. Insulin pen devices were first introduced over 20 years ago and have evolved to provide significant practical advantages compared with the vial and syringe. Pen devices are now used by patients with diabetes worldwide, but there are marked geographical variations in the use of reusable and disposable pens. In some countries the vial and syringe is still the most popular method of administering insulin, whereas in other countries the use of reusable or disposable pens is more prevalent. Therefore, the aim of this review is to discuss the factors that seem to be involved in these differences, which include patient access to insulin, cost, and physician/patient awareness and preference. Inpatient use of insulin is also common, and the use of insulin pens could offer substantial benefits in this patient population, not only during the admission period but also after discharge from the hospital. However, the evidence base for inpatient use is still weak, and more studies are needed to investigate the use of insulin pens in this patient population.