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glatiramer acetate, injection depth, multiple sclerosis, self-injection, subcutaneous thickness



  1. Masid, Maria Luisa Sanchez
  2. Ocana, Rosalia Horno
  3. Gil, Maria Jesus Diaz
  4. Ramos, Maria Concepcion Ramirez
  5. Roig, Matilde Escutia
  6. Carreno, Maria Rosario Coll
  7. Morales, Jaime Cordero
  8. Carrasco, Maria Luisa Vergara
  9. Hidalgo, Leonor Mariana Rubio
  10. Felices, Ana Maria Bernad
  11. Castano, Adela Harto
  12. Romero, Purificacion Castaneda
  13. Martinez, Pablo Francoli
  14. Sanchez-De la Rosa, Rainel


ABSTRACT: Background: The perceived pain on injection site caused by subcutaneous (SC) self-injection may negatively affect acceptance and adherence to treatment in patients with multiple sclerosis (MS). Pain on injection may be caused by inaccurate injection technique, inadequate needle length adjustment, or repeated use of the same injection body area. However, information is lacking concerning the optimal needle depth to minimize the injection pain. Objective: The purpose of this program was to characterize the perceived injection-site pain associated with the use of various injection depths of the autoinjector of glatiramer acetate (GA) based on SC tissue thickness (SCT) of the injection site. Methods: This was a pilot program performed by MS-specialized nurses in patients with MS new to GA. Patients were trained by MS nurses on the preparation and administration of SC injection and on an eight-site rotation (left and right arms, thighs, abdomen, and upper quadrant of the buttock). The needle length setting was selected based on SCT measures as follows: 4 or 6 mm for SCT < 25 mm, 6 or 8 mm for SCT between 25 and 50 mm, and 8 or 10 mm for SCT > 50 mm. Injection pain was rated using a visual analog scale (VAS) at 5- and 40-minute postinjection and during two 24-day treatment periods. Results: Thirty-eight patients with MS were evaluated. The mean SCT ranged from 15.5 mm in the upper outer quadrant of the buttocks to 29.2 mm in the thighs. The mean perceived pain on injection was below 3 for all the injection sites, at both time points (5 and 40 minutes) and during both 24-day evaluation periods. The mean VAS scores were significantly greater after 5 minutes of injection compared with that reported 40-minute postinjection during both 24-day treatment periods and for all the injection areas. Mean VAS measures at 5- and 40-minute postinjection significantly decreased during the second 24-day treatment period with respect to that reported during the first 24 SC injections for all injection sites. Conclusions: Our findings suggest that the adjustment of injection depth of SC GA autoinjector according to SCT of body injection areas is suitable to maintain a low degree of postinjection pain. Moreover, our results also may indicate that the use of needle lengths of 6 mm or shorter is appropriate with regard to injection pain for adult patients with MS with SCT < 50 mm.