8 MIN READ

Auto-injectors: choosing the right path

The auto-injector market is one of the fastest growing in the sector, driven by a shift towards the self-administration of widely used therapies, and a real need for market differentiation. But with market expansion has also come a bewildering range of development options, confusing for both new and established drug companies.

According to Visiongain, the pen systems and auto-injector market is currently worth an estimated $0.67bn, and is predicted to grow by an impressive 10-15% annually, reaching $1.71bn in 2015. This buoyancy was clearly demonstrated at the recent PDA conference (Universe of Pre-Filled Syringes), held in Basel, in November 2011, where an impressive array of auto-injectors was on display from suppliers from around the world including SHL, BD, Ypsomed, Owen Mumford and Dali.

Two key drivers lie behind this success. Firstly, the auto-injector provides a real alternative to the vial and syringe generally administered by a healthcare professional, enabling patients to safely take control of their own medication for conditions such as diabetes, rheumatoid arthritis and ankylosing spondylitis. This improves the efficiency of healthcare provision while also increasing the independence of patients who use injected therapies.

But secondly, the drugs (or biologics) available for these conditions have to compete in an increasingly crowded space where well-known therapies jostle with competitive offerings such as high value ‘biosimilars’ (which replicate established drugs that have come off-patent) and ‘biobetters’ (new and improved versions of older, often off-patent drugs). With the difference between biosimilars being negligible, the nature of the delivery device and resulting patient experience can become the influential factor in the success of a drug launch. Companies wanting to enter, or remain, in this sector are therefore shifting development emphasis away from replicating the therapy then the device, to simultaneous therapy and delivery device design. But on choosing this path they soon face a confusing range of development options. For many years we have helped clients find their way through this particularly complex maze, a process we begin by reviewing the three possible outcomes:

‘Ground up’ development – a completely new device development process, instigated in-house but rarely chosen not only because of the costs involved, but because the expertise required is rarely core to the pharmaceutical company. However, this route can deliver a precisely tailored solution and unique selling opportunity, as well as a potential IP position that can support future drug / device combinations.

Off the shelf, but tied to manufacture – many companies offer a range of off the shelf auto-injector devices ready to be customised, but with subsequent volume manufacture as part of the package. Although this option is ideal for many applications, it does mean that device design may be constrained by predetermined manufacturing capability, which can be a disadvantage if particular patient requirements have to be met. Off the shelf, but licensed – many smaller companies are developing interesting new technologies in this area, but are looking for licensing opportunities only. This can represent an interesting avenue of investigation, but skill is needed to find these companies in the first place, assess the designs available and their long term potential, and then determine the manufacturing strategy required. The development status and technical feasibility of these options can be wide ranging, and few companies want to risk being first with an unproven technology.

But before committing to a development route, it is essential to undertake a fundamental review of the whole development process, examining – in advance – all the key decisions that have to be made. The results of this proactive analysis can then be used to confirm the right development path, and make sure the resulting auto-injector fits the original brief. Our analysis focuses on eight general areas of investigation:

– Step 1

Choosing primary packaging

As a combination device, the autoinjector wraps a sophisticated delivery mechanism round a drug-filled container, known as the primary packaging. Decisions regarding the type of primary packaging used are often made early in the process to ensure it does not affect the stability of the drug, and to allow primary packaging development to progress on a different timeline to that of the device, as clinical studies may be necessary. The choice of primary packaging is therefore fundamental to subsequent device design. Glass packaging ensures stability, but can also be fragile in use and offers limited accuracy, whereas plastic alternatives now being developed can improve accuracy, offer greater flexibility in functionality and can incorporate features designed to interact with the device. However, trials are needed to demonstrate that the plastic used is compatible with the drug.

– Step 2

Defining user needs

User needs and expectations must be acknowledged at an early stage in the process so that subsequent device design addresses usability issues such as safe use (which can vary greatly depending on the user and their condition), and delivers a positive user experience. As noted earlier, where a difference in therapeutic efficacy is perceived as minimal, users and their clinicians may place significant emphasis on the convenience of the autoinjector design over the drug it contains, so understanding user motivation from the start of the process can increase the chances of eventual success.

– Step 3

Development status

Some companies may opt to develop their own, brand new auto-injector despite there being many options already available. But reaching that decision can be difficult with so many criteria to assess. Firstly, the device must be usable, compatible with the primary container, and able to handle the volume and characteristics of drug required. Design availability becomes the next big issue, as development time will be required if an appropriately skilled and experienced team is needed to move the design to where the drug company needs it to be. A gap analysis that considers the competence of the development or manufacturing partner, versus the skills required to complete the programme early, can help reduce the eventual time taken to get to the ideal device to manufacture and launch.

– Step 4

Determining robustness

Potential device designs have to prove their robustness throughout their intended life in use (from manufacturing and storage to use and disposal) especially if the device is multi- rather than single use. An understanding of the risks and weaknesses in a design is important, and this can mean commissioning tests and evaluation during the selection process if the device supplier cannot provide the information required. Once again, thinking through these considerations in advance can help guide initial decision-making, and streamline the longer-term process.

– Step 5

Assessing manufacturing options

In the vast majority of cases, device manufacture is handled by a third party which could be the company supplying the basic device technology. If not, then potential manufacturers have to be found and assessed in terms of their technical capability, quality control, and their potential contribution to the device development process, embodied in a realistic development plan. Manufacturing requires a longterm contractual relationship, so understanding the implications of such a relationship in advance can help guide early decisions.

– Step 6

Cost

Auto-injector development may not be as price sensitive as other areas of medical device design, mainly because primary value remains with the drug. However, costs should still remain realistic and competitive, and so should be thought through up front.

– Step 7

Regulatory requirements

The ideal development route is one designed to cope with the regulatory hurdles that the device will have to clear before it gets to market. An off the shelf design may have already gained certain levels of regulatory approval with other partners, but device adaptation will prompt further rounds of assessment. Seeking early advice as to the likely regulatory challenges can help forecast the route approval will take, and hence the timing of development milestones that a programme will need to adhere to.

– Step 8

Commercial considerations

Even though the development process may take several years, it is still important to look ahead and envision the commercial context in which the device will be available, in terms of speed to market, IP position, and exclusivity.

Increasingly, pharmaceutical companies recognise not only the potential profitability of therapies delivered via an auto-injector, but also that patients have come to expect a high standard of convenience from an injectable device. The generation of patients happy to be injected using a syringe is being replaced by patients who expect devices that are safe to handle, virtually infallible in operation, and which give them greater freedom and convenience to manage their condition wherever they may be. Exciting new developments in auto-injector technology are now resulting in innovative designs capable of meeting a wide range of user needs, but despite these developments, defining the ideal auto-injector – one which meets regulatory standards and which patients will actively accept – remains a real challenge. We find that by asking our clients the right questions as early as possible, clear and appropriate goals and objectives can be defined at the outset, and these will determine the development route with the best chance of delivering a successful end result.

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