title: Perceptions and Preferences of Two Etanercept Autoinjectors for Rheumatoid Arthritis: A New European Union-Approved Etanercept Biosimilar (Benepali®) Versus Etanercept (Enbrel®) - Findings from a Nurse Survey in Europe.
abstract: BACKGROUND
  Enbrel®(etanercept: manufactured by Immunex Corporation, Newbury Park, Thousand Oaks, CA 91320, USA) was the first biological disease-modifying anti-rheumatic drug approved for the treatment of rheumatoid arthritis (RA) in Europe. More recently, an etanercept biosimilar (Benepali®: manufactured by Biogen Inc, Cambridge, MA 02124, USA) was approved in the European Union. The perceptions and preferences of the Benepali autoinjector versus Enbrel MYCLIC autoinjector were evaluated by nurses from Europe.
  
  
  METHODS
  The survey involved a 25-min face-to-face questionnaire-interview with nurses from France, Germany, Italy, Spain, and the UK, experienced in training patients on using the Enbrel MYCLIC autoinjector. Nurses viewed an instructional video and device-handling leaflet, received a live demonstration on the Benepali autoinjector and had access to both Benepali and Enbrel MYCLIC training autoinjectors. Nurses rated the importance of ten autoinjector attributes on a scale of 1-7 (1 = not important at all; 7 = extremely important) and provided their autoinjector preferences based on specific attributes. Nurses also gave their opinion on which autoinjector their patients with RA would prefer.
  
  
  RESULTS
  A total of 149 nurses participated in this survey (France, n = 30; Germany, n = 40; Italy, n = 30; Spain, n = 19; UK, n = 30). 'Easy to operate the self-injection' was ranked as the most important attribute (mean score of 6.8), followed by 'easy to grip' (6.6) and 'intuitive/self-explaining usage' (6.6). Nurses preferred the Benepali autoinjector, with attributes of 'easier to operate' and 'more intuitive to use' being strong differentiators compared with the Enbrel MYCLIC autoinjector. Most nurses (86%) reported that their patients would prefer the Benepali autoinjector over the Enbrel MYCLIC autoinjector. 'Easy to operate the self-injection' and 'button-free autoinjector' were key drivers when selecting an autoinjector.
  
  
  CONCLUSIONS
  Based on these survey results, nurses in Europe reported a preference for the Benepali autoinjector compared with the Enbrel MYCLIC autoinjector for the majority of attributes assessed. In particular, attributes of 'easy to operate' and 'more intuitive/self-explaining to use' were highly rated for the Benepali autoinjector, which may allow easy handling of the autoinjector.
  
  
  BACKGROUND
  Biogen International GmBH.
authors.affiliation: Biogen International GmbH, Zug, Switzerland. Kunal.thakur@biogen.com.
authors.forename: Kunal
authors.initials: K
authors.lastname: Thakur
authors.affiliation: Kantar Health GmbH, Munich, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Biberger
authors.affiliation: Biogen International GmbH, Zug, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Handrich
authors.affiliation: Biogen International GmbH, Zug, Switzerland.
authors.forename: Mourad Farouk
authors.initials: MF
authors.lastname: Rezk
keywords: Autoinjector; Benepali; Biosimilar; Enbrel; Etanercept; Nurses; Rheumatoid arthritis