July 14, 2023 – “I've always been a little afraid of needles,” says Heather, 65, a Southern California resident, as she recalls a long-ago highschool biology class. The teacher asked everyone to prick their fingers to search out out their blood type. It took her the complete class to assemble her courage, says Heather, who asked that her real name not be used for privacy reasons, but she did it.
Several a long time later, she faced the issue. Her doctor decided to inject the bottom dose of Ozempic (semaglutide) once every week along with her oral metformin dose to maintain her blood sugar levels under control.
“It's a tiny little needle and an automatic injector,” Heather told herself, but she felt like she was back in highschool biology class. So her husband took over the duty of administering the primary dose. It wasn't nearly as bad as she imagined, she said. The needle was short and thin, she said.
“I felt the medication take effect a little and felt a slight stinging. Then the next week I did it myself,” she said.
Heather now not needs Ozempic, and her blood sugar levels are well under control with metformin. But she and all of us must expect to should take more injections in the longer term, experts say. The era of do-it-yourself medicine, i.e. self-injection at home, is here, growing, and showing no signs of slowing down.
In the past, self-injected medicine for diabetics has consisted primarily of insulin and, for people at high risk for blood clots, anticoagulants, says Eric J. Topol, MD, editor in chief of Medscape (WebMD's sister publication for healthcare professionals), professor of molecular medicine, and executive vice chairman of Scripps Research in La Jolla, California.
“Fast forward,” said Topol. “Now we have all these drugs for autoimmune diseases [that can be self-injected]. We have these drugs for obesity, for diabetes, we have the powerful cholesterol lowering drugs, the drugs like Repatha [evolocumab]. Here, people have to inject two or three different medications every other week.”
All this, he said, came after many people claimed to have a “needle phobia” when offered a COVID-19 vaccine just two years ago. In a British Study, Researchers who surveyed more than 15,000 adults and compared them to a sample of the general population concluded that about 10% of vaccine hesitancy was due to fear of blood, needles or invasive medical procedures.
“And now we live in a world where we are training the public to give themselves injections,” Topol said.
The self-injected drug market is growing, and there are no signs of slowing down, analysts report. While estimates vary widely, analysis estimated that the global self-injection device market would be valued at $6.6 billion in 2021 and grow at a CAGR of nearly 6% from 2022 to 2030.
Self-injection devices include prefilled syringes or pens and auto-injectors. According to a market study from August 2021 reviewNearly 80 auto-injectors were developed by more than 20 pharmaceutical companies. When researchers evaluated 2,964 injections from the auto-injectors, only 12 device failures occurred, corresponding to a failure rate of 0.40%.
Chances are, someone you know is injecting themselves with medications such as Humira (adalimumab) for arthritis, Repatha (evolocumab) to control cholesterol, Dupixent (dupilumab) for asthma, or even Ozempic (semaglutide) to control diabetes or Wegovy (semaglutide) for weight loss.
According to George I'ons, head of product strategy at Owen Mumford Ltd. in Oxford, UK, which designs, develops and manufactures injectable drug delivery systems for the pharmaceutical, biotech and generics industries, three main factors are responsible for this trend. These include:
- Staff shortages in medical clinics and hospitals
- Financial pressure on health systems
- A growing, ageing population that is likely to require more medication on a regular basis
Allowing patients to give themselves the injections when possible not only saves time and money, but of course also saves patients a trip to the clinic and often a co-payment. “The more people can do themselves, the less staff must be spent on it,” I'ons said. That means staff can spend more time on the areas that really need attention. The 20 or 30 minutes of clinic time that doesn't have to be spent administering medication can be put to good use, he said.
Improved devices, needles
While needle-phobes shudder at the trend toward self-injectors, ongoing improvements to the devices are aimed at convenience. For example, I'ons said, “With many auto-injectors, the needle is hidden before and after use.” The user just feels a bit of plastic on the skin.
Needles have often turn out to be so thin that, a minimum of with some devices, “you easily don't even feel the thing going in,” he said. For insulin administration, needles have turn out to be thinner and shorter over time, I'ons said.
But not all medications administered with self-injectors could be administered with the smallest needle, he said. Some drugs may require larger needles on account of their viscosity or thickness.
When people complain of pain during injection, they will not be feeling the tiny needle however the drug itself or considered one of its inactive ingredients, I'ons said. He pointed to the case of pharmaceutical giant AbbVie, which removed the buffer citrate from Humira (adalimumab) and offered a citrate-free version in 2018 because citrate was related to pain on the injection site.
The firms said they're specializing in technological advances to make self-injections less uncomfortable. “Thanks to significant technological advances and our investments in research and development, Lilly has been able to test a variety of different injection methods over the years,” Dr. Nadia Ahmad, executive vice chairman and medical director of clinical development for obesity at Eli Lilly & Company, said in an announcement.
Some people prefer the injections to the tablets, she said, because “consistent use can lead to better adherence and effectiveness in some cases.”
At Amgen, an executive said demand from patients and providers is growing “for flexibility in how we administer our medicines.” Jyothis George, vice chairman and head of world primary care medical therapeutics at Amgen, said in an announcement that sales of Repatha, for instance, rose 32% within the U.S. in the primary quarter of this 12 months. In February, the FDA approved self-administration of Tezspire (tezepelumab-ekko), developed by Amgen and AstraZeneca, for patients with severe asthma.
Education promotes self-injection skills
Getting patients used to self-injection is a component of the every day work of Amy Hess-Fischl, an authorized diabetes educator and registered dietitian who works as a diabetes educator on the University of Chicago. “When they sit down, I give them a needle, a syringe, and say, 'Go ahead and inject.' When they do that, they say, 'Oh my God, it's so small.'” That takes away their fear of the unknown, she says.
She talks about insulin injections. “With these other injectables, you don't even see the needle in many cases.”
She reminds patients that needles are generally getting smaller, each in length and in thickness or strength. Some needles are actually so short and so small that they could be in comparison with an eyelash, she said.
She also reminds patients that self-injections could be empowering. “It's about patient-centered care. I think this new revolution in injectables will improve patient-centered care and reduce anxiety.”
Support and education are essential, she said. While there are online resources for self-injection, the human touch stays essential, she said. Any health care provider who prescribes a self-injection medication, Hess-Fischl said, “needs to have a plan for where to send the patient to make this successful.” If the health care provider isn't helpful, she suggests patients call the drug manufacturer, and staff there should have the opportunity to offer them instructions or tell them where to get the instructions.
The next market?
Many medications could be self-injected, but not all. Many patients with chronic diseases depend on medications that have to be administered intravenously, which implies spending hours in a clinic or other facility.
One obstacle is the high viscosity of a few of these drugs. This makes it unattainable to supply and inject a number of the monoclonal antibodies within the small quantities required for subcutaneous injections.
Science could change that, says Jeffrey Hackman, CEO and chairman of Comera Life Sciences, who has developed methods to place some biologics right into a form that could be administered under the skin and injected by patients themselves at home.
“I don’t think we’ll ever get away from intravenous medications. [entirely],” he said. But he hopes that inside the subsequent five to seven years, some biologics which are now administered intravenously in clinics will have the opportunity to be self-injected at home, much faster than today's process requires.