Since 1998, when Enbrel became the first biologic drug approved for arthritis, self-injection has become more common. Self-injection had been an option for the disease-modifying anti-rheumatic drug methotrexate for a number of years, but now, several biologic arthritis drugs require self-injection.
The idea of self-injection can be daunting but there are certain steps to take and tips to follow that make it much less of a burden than you imagine. It has been shown that the majority of patients do get over anxiety related to self-injection, once they have been trained.
The nurse at your doctor's office will coach you the first time or two -- whatever you agree is necessary. You can also watch the demonstration videos that are made available by drug manufacturers, so you know what to expect regarding self-injection of arthritis drugs.
Which Biologic Drugs Are Self-Injectable?
TNF-blockers Enbrel (etanercept), Humira (adalimumab), Simponi (golimumab), and Cimzia (certolizumab pegol) are all administered by subcutaneous (under the skin) self-injection. Kineret (anakinra), a biologic drug that inhibits the action of interleukin-1, is also given by subcutaneous self-injection.
TNF blocker Remicade (infliximab), as well as Rituxan (rituximab) which targets CD20-positive B-cells, T-cell co-stimulation modulator Orencia (abatacept), and Actemra (tocilizumab) which blocks IL-6 are not given by self-injection. Instead, they are administered by intravenous infusion.
Generally, the drugs which are suitable for self-injection are injected just under the skin with a needle in the front of the thighs, the stomach (avoiding the 2-inch area around the belly button), or the outer area of the upper arms (if another person is helping with your injection).
Several of the medications are available in an autoinjector so you never even have to see the needle. Great little inventions, but some insurance plans don't cover the autoinjectors and only cover the pre-filled syringes or the syringe and vial of medication. Be sure you check on this so there are no surprises in terms of cost or in terms of what you will be supplied.
If using a pre-filled syringe, you need to:
- Take your medication out of the refrigerator 15 minutes ahead of time.
- Wash your hands thoroughly.
- Clean the skin at the injection site with an alcohol swab.
- Let the area dry for about 20 seconds.
- Remove the needle cover without ever touching the needle.
- With one hand, pinch up the area where you intend to inject.
- With the other hand, hold the syringe like a dart at a 90-degree angle or at a 45-degree angle (follow instructions for your specific drug).
- Insert the needle into the pinched up skin quickly and firmly.
- Push the plunger of the syringe down slowly until the syringe is empty.
- Withdraw the needle and dispose of the needle and syringe in a sharps container.
If using a syringe and a vial of medication, there will be an additional few steps to fill the syringe manually. If you use an autoinjector the process is even more simple than with a pre-filled syringe.
Video Demonstrations of Self-Injection Method
- Demonstration of Enbrel Self-Injection With Pre-filled Syringe, SureClick Autoinjector, or Vial Method (enbrel.com)
Self-Administer (SC) Injections. Health Information. University of Wisconsin-Madison School of Medicine and Public Health. 10/19/2009.
Teaching patients to self-inject: pilot study of a treatment for injection anxiety and phobia in multiple sclerosis patients prescribed injectable medications. J Behav Ther Exp Psychiatry. 2002 Mar;33(1):39-47. http://www.ncbi.nlm.nih.gov/pubmed/12389798