Would you like that IV, Subcut or Oral?

By Dr Irwin Lim, Rheumatologist

Let's assume you have a serious disease and your doctor has recommended more serious therapy. Stronger medications.

You don't really like the idea of more medications but you know you don't really have that much of a choice given your disease is not controlled well enough.

The options/choices in front of you (and you haven't had experience of any):

• An intravenous medication that requires infusion every 6-8 weeks. This means that you need to attend a hospital or an infusion centre for a few hours each time and have the medication go through one of your veins.
• An intravenous medication that requires 2 infusions separated by a couple of weeks every 6 months.
• Two different choices of intravenous medication that are given monthly.
• 5 different choices of injections that are given subcutaneously. By that, I mean just under your skin. These are given by a pre-filled injection pen device or by a pre-filled syringe with a small needle. The frequency that you will need to self inject ranges from once weekly to once fortnightly to once monthly.
• An oral tablet that you must take twice a day, every day.

Let's assume that all of these different medications have been shown in high grade scientific trials to be effective in roughly the same percentage of patients to roughly the same degree. I'll even tell you that at this stage, there are no definitive head-to-head comparisons to help you make up your mind which one is superior.

To make it even easier or harder (depending on your perspective), let's say that the side effect profiles are all a little different between the agents but in terms of serious (and this is open to interpretation) side effects, there is little difference.

Importantly, the cost of each option is also roughly the same.

Which would you choose?

Intravenous, Subcutaneous or Oral?

And why?