Higher Risankizumab Adherence with New Injection Device

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Trypanophobia, or fear of needles, affects 20% to 50% of adolescents and 20% to 30% of adults. While it often decreases with age, it can interfere with medical treatments, especially those requiring injections.¹ This issue is particularly relevant for chronic conditions like psoriasis, where injectable biologic drugs are used for management. Researchers behind a recent study noted needle fear can lead to noncompliance with treatment regimens, impacting drug effectiveness and health outcomes.²

Biologic treatments vary in administration frequency: anti-TNF therapies require bi-weekly or weekly injections, anti-IL-17 every 4 weeks, and anti-IL-23 every 8 to 12 weeks. Prefilled syringes or pens with concealed needles can help mitigate this fear.³ With this in mind, researchers used the Self Injection Assessment Questionnaire (SIAQ) to assess the benefits of the Risankizumab prefilled 150-mg pen and identify any psychological or social barriers affecting adherence to the injection schedule.⁴

Methods

The study assessed patients with moderate to severe psoriasis who had been using risankizumab prefilled syringes for over 6 months but experienced reduced efficacy and adherence due to needle fear. It included patients aged 18 or older who were eligible for systemic biologic therapy. Participants switched from using 2 75 mg prefilled injections to a single 150 mg prefilled pen of risankizumab.

Patients completed the SIAQ before and after the switch, and again after 12 weeks. The SIAQ consists of a premodule, evaluating “feelings about injections,” “self-confidence,” and “satisfaction with self-injection” before the injection, and a post module, assessing these aspects plus “pain and skin reactions,” “ease of use of the device,” and overall satisfaction after the injection.

Results

The study included 22 patients with psoriasis (12 men, 10 women) with an average age of 63 and an average disease duration of 19.7 years. The average duration of systemic therapy was 7.4 years, with 10 patients having prior biologic experience, and 6 patients (27.3%) having a history of depression.

The SIAQ showed that pre-injection scores for “feelings about injections,” “self-confidence,” and “satisfaction with self-injection” averaged 5.5, 6.2, and 6.4, respectively. Researchers found post-injection scores improved significantly, exceeding 8.5 at week 0 and rising above 9.0 after 12 weeks. Most patients found the device easy to use, with 90.9% of patients rating it as “easy” or “very easy” at week 0 and 95.5% at week 12. Similarly, a high percentage of patients reported the self-administration process to be easy and were satisfied with the method of taking their medication.

The study also explored how patients’ duration of systemic therapy and disease duration related to their SIAQ scores. They found that those on systemic therapy for more than 7 years had lower pre-injection scores, while those with over 19 years of disease duration had higher pre-injection scores. Patients with depressive symptoms had lower pre-injection scores, though these differences were not found to be statistically significant (p > 0.05).

Conclusion

Recent advancements, such as the introduction of less frequent treatment regimens and prefilled pens that conceal the needle, have shown promise in mitigating needle phobia issues. The risankizumab 150 mg prefilled pen, replacing earlier syringes, has been well-received, particularly among patients with severe needle phobia, as evidenced by improved SIAQ scores over time. This suggests that newer, more user-friendly devices can alleviate the anxiety associated with injections and enhance treatment adherence.

Researchers stated that although the study's findings on depressive symptoms and long-term therapy experience were not statistically significant, they highlight the broader impact of needle phobia on therapeutic adherence. They wrote that addressing this issue is crucial, as it can prevent loss of treatment efficacy and potential disease relapse. Overall, the study found that improving device design and acknowledging needle phobia can significantly boost patient adherence and treatment outcomes.

References

1. McLenon J, Rogers MAM. The fear of needles: A systematic review and meta-analysis. J Adv Nurs. 2019;75(1):30-42. doi:10.1111/jan.13818
2. Alsbrooks K, Hoerauf K. Prevalence, causes, impacts, and management of needle phobia: An international survey of a general adult population. PLoS One. 2022;17(11):e0276814. Published 2022 Nov 21. doi:10.1371/journal.pone.0276814
3. Bakshi H, Nagpal M, Singh M, et al. Treatment of psoriasis: A comprehensive review of entire therapies. Curr Drug Saf. 2020;15(2):82-104. doi:10.2174/1574886315666200128095958
4. 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:e13902. https://doi.org/10.1111/srt.13902