Intravenous versus Subcutaneous Drug Administration. Which Do Patients Prefer? A Systematic Review
- 631 Downloads
Intravenous (IV) drug delivery is commonly used for its rapid administration and immediate drug effect. Most studies compare IV to subcutaneous (SC) delivery in terms of safety and efficacy, but little is known about what patients prefer.
A systematic review was conducted by searching seven electronic databases for articles published up to February 2014. Included studies were randomized controlled trials (RCTs) and/or crossover designs investigating patient preference for SC versus IV administration. The risk of bias in the RCTs was determined using the Cochrane Collaboration tool. Reviewers independently extracted data and assessed the risk of bias. Any discrepancies were resolved by consensus.
The search identified 115 publications, but few (6/115) met the inclusion criteria. Patient populations and drugs investigated were diverse. Four of six studies demonstrated a clear patient preference for SC administration. Main factors associated with SC preference were time saving and the ability to have treatment at home. Only three studies used study-specific instruments to measure preference.
Results suggest that patients prefer SC over IV delivery. Patient preference has clearly been neglected in clinical research, but it is important in medical decision making when choosing treatment methods as it has implications for adherence and quality of life. If the safety and efficacy of both administration routes are equivalent, then the most important factor should be patient preference as this will ensure optimal treatment adherence and ultimately improve patient experience or satisfaction. Future drug efficacy and safety studies should include contemporaneous, actual patient preference where possible, utilizing appropriate measures.
KeywordsTrastuzumab Human Epidermal Growth Factor Receptor Bortezomib Patient Preference Abatacept
Conflict of interest
Miss Kelly Stoner, Dr Helena Harder, Professor Lesley Fallowfield, and Dr Valerie Jenkins have no conflicts of interest to declare. SHORE-C received funding from Hoffmann-La Roche to conduct the PREFER study. Kelly Stoner and Helena Harder conducted the literature search and article selection. All authors contributed equally to data interpretation and writing of the systematic review.
- 1.Josephson D. Patient preparation and site selection for peripheral IV infusion therapy. Intravenous infusion therapy for nurses: principles and practice. 2nd ed. New York: Thomson Delmare Learning; 2004. p. 143.Google Scholar
- 12.Ismael G, Hegg R, Muehlbauer S, Heinzmann D, Lum B, Kim SB, et al. Subcutaneous versus intravenous administration of (neo)adjuvant trastuzumab in patients with HER2-positive, clinical stage I-III breast cancer (HannaH study): a phase 3, open-label, multicentre, randomised trial. Lancet Oncol. 2012;13:869–78.CrossRefPubMedGoogle Scholar
- 17.Beerse, Belgium. Subcutaneous Velcade approved in the EU for the treatment of multiple myeloma. Published 28/09/2012. http://www.investor.jnj.com/releasedetail.cfm?ReleaseID=710106. Accessed 19 Mar 2014.
- 26.Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration 2011. http://www.cochrane-handbook.org. Accessed 19 Mar 2014.
- 33.Bjoerner JB, Damsgaard MT, Watt T, Bech P, Rasmusen NK, Kristensen TS, et al. Danish manual for SF-36. Copenhagen: Lif Lægemiddelindustriforeningen; 1997.Google Scholar
- 37.Huynh TK, Østergaard A, Egsmose C, Madsen OR. Preferences of patients and health professionals for route and frequency of administration of biological agents in the treatment of rheumatoid arthritis. Patient Prefer Adherence. 2014;20(8):93–9.Google Scholar