Enabling Adherence Via Multidose Injectors With SHL Medical's Courtney Nicholas Sutton

Courtney Nicholas Sutton, Head of Product Strategy at drug delivery systems developer and manufacturer SHL Medical, joins Supplier Horizons host Tom von Gunden to discuss opportunities for multidose pen injection technologies to advance patient adherence and therapeutic benefits. With the primary treatment scenario being chronic, cardiometabolic diseases, the discussion covers topics including dosing accuracy, human factors, and device reusability. 

Episode Transcript

Tom von Gunden, Chief Editor, Drug Delivery Leader

Welcome to another episode of Supplier Horizons. My name is Tom von Gunden, Chief Editor at Drug Delivery Leader and your host for the episode. Today, I am pleased to be joined by Courtney Nicholas Sutton, who is Head of Portfolio Strategy at drug delivery systems developer and manufacturer SHL Medical.

Welcome, Courtney.

Courtney Nicholas Sutton, Head of Product Strategy, SHL Medical

Thank you, Tom. I'm very happy to be here today.

Well, I'm pleased to have you here. It’s my pleasure.

So, let's go ahead and dive in. We will be talking about the science and technology being worked on there by you and the folks at SHL Medical. But before we get to that, I know that a focus for you folks that we're going to talk about today is patient populations and targets out in the cardiometabolic space.

So, let's just pause there for a moment and tell us about what you and the folks there see when you look over that horizon. What are some of the patient experiences? What are some of the options they have for treatments and methodologies for treatment? With what efficacy, with what limitations that have you folks thinking about moving the dial forward, so to speak, maybe even literally, as we'll see, in terms of advancements and innovations.

Sounds great. Thanks, Tom.

So, the cardiometabolic space is really booming. And I think it really can't even go a week without seeing it in the news. It's really an exciting time for our industry and is, rightfully so, pushing innovation forward as such. With the cardiometabolic therapies that have emerged in the last five to seven years, we've seen a really diverse group of patients start to be served by these devices — a patient population that's probably more diverse than we've seen in a really long time.

This group includes different dexterity and cognitive challenges. It also includes many device-experienced, as well as device-naïve, patients. And all of those populations have different needs that need to be addressed by the delivery systems and ultimately the products that are being used. So, we've been listening and hearing what some of those challenges are.

The first products to go out there have been primarily supplied in autoinjector devices. So single-use autoinjectors, which are great products. We have many of them, and we believe in them.

But while they're very convenient and easy to use, it is also quite challenging in a weekly setting to use those forever and have those be the only device that is utilized to deliver these types of therapies.

We've also seen the emergence of multidose pens being used in this space, particularly outside of the U.S, and these pens generally have four to six doses in them.

Making them a bit more sustainable, but a little bit less convenient for the patients out there. So, we see quite a few different solutions, and everyone's trying to get to the market as fast as possible. So, it makes sense to use things that were readily available at the time.

But as this market develops, we feel very strongly that there needs to be solutions in place

for the delivery devices that truly meet the needs of this large and diverse patient population.

Yeah, gotcha. Well, thanks for that background. It has led us to a really good transition point, which is: When we talk about that kind of technology, which I would characterize based on your description as multi-dosed, fixed-dose pen injection approaches. What's different about what you and the folks there are working on developing, both in terms of the design but also, of course, in terms of the usability and patient interface component of it?

Absolutely. So, perhaps before I dive into that, I'll just give everybody a quick overview of what I meant by the multi-dose pens that are out there now. And with that, I think the keys are that these multi-dose pens were originally designed and intended for specific patient populations. So, those around insulin or human growth hormone — products that are dosed very frequently and require the patient to tailor the dose to their specific needs.

Now, when we talk about this new patient population and using those products in that patient population, we believe that we can differentiate as having something that's a little bit in between an autoinjector and a multi-dose pen that takes the best of both of those areas.

Because with the traditional multi-dose pen, for those not familiar, the patient has to dial their specific dose. And prior to actually dialing the first dose from each pen that they use, they have to prime the device to remove the air. But they may not be familiar with what exactly priming is, what exactly they're doing. And it's done a little bit differently on every device out there.

So, it's a source of confusion for many patients. And dialing a dose also can be a source of confusion for them, and many of them lack confidence in the dose that they've dialed and whether that's the correct dose or not.

 So, we think that, by taking the key attributes and everything people love about an autoinjector, which is something where the dose is preset — you can't tailor, or you can't modify it in any way — and a multi-dose pen, which can be used for multiple doses, and putting that together in a truly fixed-dose format, we can address the needs of this patient population and ensure that they feel quite confident in the dose that they are delivering.

Yes, great, thanks for that. And so, I'd be interested in knowing a little bit more. I'm intrigued by the idea that you've got a multi-dose technology that is quote-unquote ‘dialing up’ doses. But I know one of the key goals and differences that you're working on there is the idea of ensuring a fixed dose. So, tell us a little bit more about how that works.

Yes, of course. So, and maybe as I talk about dialing, I'll differentiate a little bit between traditional multi-dose pen dialing and the fixed-dose pen dialing that we're working on.

Please do, please do, it would help me as well. Thanks.

So, for traditional multi-dose pen dialing, what happens is the patient will — it's variable, so there are various doses printed on the dial that the patient can dial to. And they make a decision and they choose what they're dialing to. And in some products in this space, companies have used that technology but only marked certain doses on that dial. You can still, as a patient, select other doses even if they aren't marked, but you're not supposed to. But it doesn't limit that use error.

Now, when we talk about the fixed dose dialing, the benefit there is that you cannot choose a different dose. Think of it as loading, loading a spring, where you dial to load the spring, but the device cannot be activated until that entire dose is dialed. Therefore, there's no judgment on the patient's part. It is either dialed or it is not dialed. So, when the device is dialed, then the button pops up for the patient to be able to complete the injection.

Gotcha. All right, thank you for that clarification.

So, whether it's in the design itself, whether it's in the patient usability and scenarios in the patient landscape and those populations that you talked about earlier: Are there additional, ‘what's next’ problems to be solved, questions to be answered, challenges to overcome that you and the folks are looking to — in this case, I will use the pun — ‘move the dial’ in terms of advancing the technology or the science or the user experience.

Yes, absolutely. Obviously, we feel strongly about the fixed-dose nature in this space and want to advance that. And part of that will be acceptance of the U.S. market. We talked earlier about how that market is primarily driven by convenience. And therefore, autoinjectors dominate the space there.

So, we believe something that is a bit in between — gives that autoinjector simplicity versus the pen complexity but still has some of those key benefits of a multi-dose pen — can really help move that market forward and allow more products that haven't launched in that market to launch in that market. Because, inherently, if you have a product that contains four doses instead of one, it's a more cost-effective solution and, therefore, hopefully, has more viability of making it to the market as well. So, it's a benefit for patients and for pharma alike.

Gotcha. And just to pick up that thread of convenience turned into reducing the amount of frequency with which somebody has to get a new device, it sounds to me like there's an obvious sustainability benefit there as well. So, do you want to talk about how you folks think about that when it comes to the design and the frequency of use?

Absolutely. There is a major sustainability benefit here. Of course, going from four to one [doses in one device] is a benefit all in itself, and especially if you look at the full value chain and everywhere along the way that that has impact.

But also, as we've developed this device, we have really tried to incorporate today's best practices from a sustainability perspective so that it really has that built in by design. So, we utilized eco-design principles in the engineering of the product. We included bio-based materials in the material selection for what was utilized in the product as well as having recycled and recyclable packaging along the way. So, really trying to build in sustainability by design, ensuring that it really is best in class for today's view.

Gotcha. Well, I like to end these discussions by looking out over the horizon, whether that's near or far, whenever we believe we'll arrive at the future state that you and the folks there are hoping that we get to. So, as you look out over that horizon, Courtney — and feel free, by the way, to either reiterate points you've already made or add to or extend: What are your hopes and dreams for you personally and as you represent the folks at SHL Medical in terms of what the lives and health of patients — their experience and the efficacy of their treatments — might be like, should we arrive at the future state, helped in large part by these advancements that you folks are working on?

Yes, thank you, Tom. Ultimately, we strive for the independence of patients. That's always our goal as we're looking at the products that we're developing. I think in this space in general, you see a lot of advancement with this, partially just driven by the sheer size of the patient population and what they demand. You see things like direct-to-consumer models, but we really do think that devices that are designed to be as easy-to-use as possible for patients become the most approachable and, therefore, allow them to self-administer as successfully as possible.

We really believe in continuing to push the boundaries of science engineering to allow this to occur in other therapy areas as well, right? Our focus is not only in cardiometabolic; it's just a really good example of where we're doing this right now. But we hope to continue to do this so that pharma can develop products that also enable patient independence.

We feel really strongly about the cardiometabolic space because, as we talked about today, there are solutions out there and they are working. But this is a really large patient population, and they do have specific needs. And we believe that there do need to be products out there that are specifically designed for them and make this as easy and confidence-inspiring as possible for them to receive their medications.

Gotcha, gotcha. Well, it all sounds very promising. Courtney, I want to thank you for joining me today to share some of the insights and perspectives on the work that's being done there at SHL Medical and how it is targeting the patient populations and needs out there. I want to thank our audience, too, for joining for another episode of Supplier Horizons. And we'll see you next time.