Perceptions and preferences of self-injectable therapies among adults living with immunoglobulin A nephropathy in the United States: a mixed-methods study

Self-injectable therapies are available as newer treatment options for Immunoglobulin A nephropathy (IgAN), but evidence on patients’ preferences for dosing, administration, and tolerability is lacking. This study explored perceptions and preferences for self-administered injectable therapies among adults with IgAN in the United States. Adults with IgAN (n = 25) participated in semi-structured virtual interviews lasting up to 60 min. After viewing images and short videos of the autoinjector and prefilled syringe used in IgAN treatment, participants discussed device preferences, dosing frequency, injection volume and injection site reactions (ISRs) using a discussion guide. Responses were audio-recorded and analyzed using directed content analysis. Nearly all participants preferred the autoinjector over the prefilled syringe (96.0% [24/25] vs 4.0% [1/25]), including all four currently receiving sibeprenlimab via prefilled syringe. Preference for the autoinjector was driven by perceived or expected reduced psychological burden, reduced pain, safer handling, increased confidence, and user-friendliness (e.g. “[…] not seeing it [the needle] […] just makes it a lot easier. Less anxiety.”). Most participants preferred every-4-week over every-week dosing (80.0% [20/25] vs 20.0% [5/25]) (e.g. “[…] not having to remember to do something every week, but instead once a month would be nice”). Pain was frequently cited as the most bothersome ISR (64.0% [16/25]). Adults with IgAN overwhelmingly preferred the autoinjector and strongly preferred the every-4-week dosing. Incorporating device and dosing preferences into shared decision-making with nephrologists may better align injectable treatment choices with factors that patients with IgAN value when choosing a therapy.