title: Subcutaneous versus intravenous bortezomib: efficiency practice variables and patient preferences.
abstract: BACKGROUND
  Subcutaneous bortezomib is noninferior in efficacy to intravenous bortezomib and is associated with a lower incidence of neuropathy in the treatment of multiple myeloma. However, there are no data assessing the effect of subcutaneous bortezomib administration on practice variables or patient preferences.
  
  
  OBJECTIVE
  To quantify the difference in efficiency practice variables and patient preferences regarding subcutaneous versus intravenous bortezomib administration in patients with multiple myeloma.
  
  
  METHODS
  This study was divided into 2 parts consisting of mutually exclusive patients: a retrospective efficiency study and a survey study. Patients' medical records were reviewed for efficiency data measures including length of infusion chair time and overall infusion center visit time in patients who received at least 6 doses of bortezomib. Patients who received at least 1 dose each of subcutaneous and intravenous administration were surveyed regarding preference, satisfaction, injection site reactions, and quality of life measures. A database was used to identify eligible patients for each portion of the study.
  
  
  RESULTS
  A review of 92 medical records demonstrated a 38% reduction in chair time (143 vs 89 minutes; p < 0.001) and a 27% reduction in infusion center visit time (169 vs 123 minutes; p < 0.001) with subcutaneous versus intravenous administration of bortezomib. Of 47 eligible patients, 60% (28) completed the survey; 68% (19; p = 0.0002) of these patients preferred and were more satisfied with subcutaneous bortezomib administration. The overall incidence of injection site reactions was 39% (11) in the surveyed population and was not significantly different between the 2 preference groups. Limitations of the study include single-center design, small sample size, and nonvalidated survey.
  
  
  CONCLUSIONS
  Subcutaneous administration of bortezomib is more time efficient for the patient and institution and is preferred by patients compared to intravenous bortezomib.
authors.affiliation: Department of Pharmaceutical Services, Emory Healthcare, Atlanta, GA.
authors.forename: Meagan S
authors.initials: MS
authors.lastname: Barbee
authors.forename: R Donald
authors.initials: RD
authors.lastname: Harvey
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Kaufman
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Wilson
authors.forename: Trevor
authors.initials: T
authors.lastname: McKibbin
authors.forename: Donald A
authors.initials: DA
authors.lastname: Hutcherson
authors.forename: Minal
authors.initials: M
authors.lastname: Surati
authors.forename: Kelly
authors.initials: K
authors.lastname: Valla
authors.forename: Katherine Sanvidge
authors.initials: KS
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001897:Boronic Acids / Q000008:administration & dosage*; D000069286:Bortezomib; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D057240:Patient Preference; D011719:Pyrazines / Q000008:administration & dosage*
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib
keywords: administration route; bortezomib; efficiency; multiple myeloma; preference; quality of life; satisfaction; subcutaneous