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Comprehensive evaluation of microneedle‐based intradermal adalimumab delivery vs . subcutaneous administration: results of a randomized controlled clinical trial
Author(s) -
Jacobse Justin,
Voorde Wouter,
Tandon Anushka,
Romeijn Stefan G.,
Grievink Hendrika W.,
Maaden Koen,
Esdonk Michiel J.,
Moes Dirk Jan A.R.,
Loeff Floris,
Bloem Karien,
Vries Annick,
Rispens Theo,
Wolbink Gertjan,
Kam Marieke,
Ziagkos Dimitrios,
Moerland Matthijs,
Jiskoot Wim,
Bouwstra Joke,
Burggraaf Jacobus,
Schrier Lenneke,
Rissmann Robert,
Cate Rebecca
Publication year - 2021
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.14729
Subject(s) - adalimumab , medicine , tolerability , pharmacokinetics , placebo , erythema , bioavailability , intradermal injection , pharmacology , urology , dermatology , adverse effect , rheumatoid arthritis , pathology , immunology , alternative medicine
Aims To evaluate feasibility of intradermal (i.d.) adalimumab administration using hollow microneedles, and to compare a single i.d. dose of adalimumab using a hollow microneedle with a single subcutaneous (s.c.) dose using a conventional needle. Methods In this single‐centre double‐blind, placebo‐controlled, double‐dummy clinical trial in 24 healthy adults we compared 40 mg adalimumab (0.4 mL) administered i.d. using a hollow microneedle with a s.c. dose using a conventional needle. Primary parameters were pain, acceptability and local tolerability; secondary parameters safety, pharmacokinetics and immunogenicity. We explored usability of optical coherence tomography, clinical photography, thermal imaging, and laser speckle contrast imaging to evaluate skin reaction after i.d. injections. In vitro protein analysis was performed to assess compatibility of adalimumab with the hollow microneedle device. Results While feasible and safe, injection pain of i.d. adalimumab was higher compared to s.c. adalimumab (35.4 vs . 7.9 on a 100‐point visual analogue scale). Initial absorption rate and relative bioavailability were higher after i.d. adalimumab (time to maximum plasma concentration = 95 h [47–120]; F rel = 129% [6.46%]) compared to s.c. adalimumab (time to maximum plasma concentration = 120 h [96–221]). Anti‐adalimumab antibodies were detected in 50% and 83% of the subjects after i.d. and s.c. adalimumab, respectively. We observed statistically significantly more erythema and skin perfusion after i.d. adalimumab, compared to s.c. adalimumab and placebo injections ( P < .0001). Cytokine secretion after whole blood lipopolysaccharide challenge was comparable between administration routes. Conclusions Intradermal injection of adalimumab using hollowing microneedles was perceived as more painful and less accepted than s.c. administration, but yields a higher relative bioavailability with similar safety and pharmacodynamic effects.