Physician Estimates of Needle Phobia Might Be Overstated Among Patients With Parkinson Disease

A survey of more than 4000 individuals with PD and their caregivers suggests that almost 90% would be willing to use subcutaneous injectable therapies to control their disease, contrasting the current anecdotal belief of “needle phobia” in this population.

The results of a recent patient survey study suggest that physicians may be overestimating patient phobia of needles when it comes to the use of injectable therapies for Parkinson disease (PD). This, the investigators suggest, might lead to a lack of prescription of intermittent subcutaneous therapies, such as apomorphine (Apokyn; Supernus), as well as novel dopaminergic subcutaneous pump therapies.1

Conducted by Rajeev Kumar, MD, neurologist, and founder, Rocky Mountain Movement Disorders Center, and colleagues, the group surveyed 4063 individuals with PD, and their caregivers/family, who reported experiencing troublesome OFF episodes. The data were presented in a poster at the 2022 Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress in Washington, DC, June 17-19.

To these more than 4000 individuals, they asked if the patient was willing to consider using a pen device to get moving again. Notably, they provided information about the self-injectable pen device, though the investigators noted that it is possible some participants did not read this information.

“Injection is a common medical procedure, yet the fear of needles can result in avoidance of treatment. Thus, the existence of ‘needle phobia,’” Kumar et al wrote. They added that, “There may be a perception among neurologists that patients may be unwilling to inject themselves due to ‘needle phobia.’ Our survey results are in stark contrast to this perception, showing 89% of patients willing to self-inject regardless of PD disease duration, when there is an expectation of associated benefit.”

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All told, 89% (n = 3615) of those surveyed responded that they or the patient with PD they cared for was willing to use a subcutaneous injectable, while only 10.7% did not. Of the surveyed population, 0.3% did not provide an answer. Among those who answered yes, 39.6% reported taking a dopamine agonist, 21.2% taking monoamine oxidase B inhibitors, 20.7% were taking amantadine, 13.2% were taking catechol-o-methyltransferase inhibitors, and 1.9% were taking subcutaneous apomorphine. In total, 45% of these individuals noted they were taking at least 2 adjuvant treatments.

As the investigators noted, length of disease duration showed virtually no differences for willingness to use subcutaneous injectable treatments. Among those with disease duration of 2 to 4 years (n = 451), 90% (n = 405) showed willingness to do so. Similarly, among those with duration of 5 to 6 years (n = 985) and 7 or more years (n = 2625), those rates were 89% (n = 879) and 89% (n = 2331), respectively.

Similar results to these have been observed in other disease states, with a 2015 study by Roth et al showing nearly identical results among patients who were candidates for the PCSK9 inhibitor alirocumab, an injectable monoclonal antibody, to reduce in LDL-cholesterol. In that study, participant acceptance of both devices was positive, with agreement regarding ease-of-use ranging from 83% to 100%. Of the 101 specialist physicians included in the survey, they estimated that 66% (for pen) and 58% (for syringe) of their patients would be willing to self-inject using the device. Of the 200 patient participants, 72% (for pen) and 63% (for syringe) expressed very high willingness to self-inject, while 96% (for pen) and 93% (for syringe) were either very willing or somewhat willing to self-inject.2

Kumar et al expressed the importance of these data by highlighting the clinical efficacy of apomorphine subcutaneous injections, which have been shown in trials to both reduce OFF episodes and have a rapid onset of action.1 OFF episodes and dyskinesia has been observed to affect nearly 40% of patients within 4 to 6 years of disease onset, jumping to an estimated 70% among those with disease duration of 9 or more years. This onset, which has, for some time now, been suggested to be between 3 and 20 minutes and lasting for 20 to 40 minutes. Additionally, the response to has been deemed “indistinguishable from that to levodopa.”3

“To test this hypothesis [of overestimation of needle phobia], a survey of neurologists is planned to assess their perception of patient ‘needle phobia,’ including how this may impact their use of these therapies, and how their attitude toward prescribing these therapies may be altered after the neurologists are educated with these patient data,” Kumar and colleagues concluded.

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REFERENCES
1. Imamovic A, Melyan Z, Kasibhatla C, Kumar K. “Needle Phobia” in patients with Parkinson’s disease (PD) experiencing OFF episodes is uncommon. Presented at: ATMRD Congress; June 17-19, 2022; Washington, DC.
2. Roth EM, Bujas-Bobanovic M, Louie MJ, Cariou B. Patient and Physician Perspectives on Mode of Administration of the PCSK9 Monoclonal Antibody Alirocumab, an Injectable Medication to Lower LDL-C Levels. Clin Ther. 2015;37(9):1945-1954.e6. doi:10.1016/j.clinthera.2015.07.008
3. Chaudhuri KR, Clough C. Subcutaneous apomorphine in Parkinson’s disease: Effective yet underused. BMJ. 1998;316(7132): 641. doi:10.1136/bmj.316.7132.641