title: Subcutaneously administered methotrexate for rheumatoid arthritis, by prefilled syringes versus prefilled pens: patient preference and comparison of the self-injection experience.
abstract: OBJECTIVE
  This multicenter, randomized, crossover study compared preference, ease of use, acceptability, satisfaction, and safety of repeated subcutaneous (SC) self-administrations with prefilled pens and prefilled syringes delivering methotrexate (MTX), in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  The study (ClinicalTrials.gov number NCT01793259) enrolled 120 patients requiring initiation or intensification of MTX therapy for RA. Patients were randomized to receive the test drug, a prefilled pen (Metex(®) PEN/Metoject(®) PEN), or the reference drug, a prefilled syringe (Metex(®)/Metoject(®)), at doses of 15, 17.5, or 20 mg MTX SC once a week for 3 weeks. This was followed by receipt of the reference drug (prefilled syringe) or the test drug (prefilled pen) in a crossover design, with each patient serving as his/her own control. Questionnaires regarding patient preference, the Self-Injection Assessment Questionnaire (SIAQ), and diaries regarding local tolerability were used to document outcomes.
  
  
  RESULTS
  Overall patient preference for the MTX prefilled pen was 75% (P<0.0001). In a six-item questionnaire, 73% to 76% of the patients preferred the prefilled pen in relation to use, acceptability, and satisfaction, and 67% of the patients confirmed that it did not take much effort to overcome SC self-injection with the pen. The SIAQ showed no clinical differences, in any domain scores, between both devices. Overall patient attitude towards self-injection at baseline was positive, as was patient experience with both devices during the study. As well, 92% of physicians and study nurses indicated that they would recommend the MTX prefilled pen to patients for future MTX treatment. The formulations were generally well tolerated.
  
  
  CONCLUSIONS
  SC self-injection of MTX with a prefilled pen was generally preferred, by patients with RA, over a prefilled syringe with regard to use, acceptability, and satisfaction. This is supported by the strong appreciation of their attending study nurses and physicians, for its convenience.
authors.affiliation: Private practice, Hildesheim, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Demary
authors.affiliation: Private practice, Dresden, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Schwenke
authors.affiliation: Private practice, Goslar, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Rockwitz
authors.affiliation: Outpatient Rheumatism Center, Erfurt, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kästner
authors.affiliation: Private practice, Halle, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Liebhaber
authors.affiliation: Private practice, Rheine, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schoo
authors.affiliation: Private practice, Lingen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Hübner
authors.affiliation: medac GmbH, Hamburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Pichlmeier
authors.affiliation: medac GmbH, Hamburg, Germany.
authors.forename: Cécile
authors.initials: C
authors.lastname: Guimbal-Schmolck
authors.affiliation: Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Müller-Ladner
keywords: injection device; methotrexate