Degarelix administration technique optimisation: Consensus findings of an international Delphi nurse panel

Abstract

What steps involved in degarelix (Firmagon®, Ferring Pharmaceuticals) administration and patient care do specialist nurses consider most important to reduce the risk of associated injection site reactions, and are there any variations in administration and materials used to support optimal injection technique? Degarelix is a GnRH antagonist indicated for the first-line treatment of advanced prostate cancer that effectively suppresses testosterone production in the testes without an initial testosterone surge and possible subsequent disease flare—both typical features associated with GnRH agonists. However, injection site reactions can occur after subcutaneous injection of degarelix, which are unpleasant for patients and may represent a limiting factor for its use by healthcare professionals. The objective of this study was to reach consensus on key steps involved in degarelix administration and patient care to minimise injection site reaction risk. Injection site reactions have been associated with subcutaneous injection of degarelix in several published studies; they are usually transient, mild-to-moderate, and occur mainly with the initial dose. Information on prevention is limited, one research group suggesting that the injection method may contribute to injection site reaction risk, and another describing specific injection techniques and strategies developed by Canadian nurses and physicians aiming to prevent degarelix injection site reactions. An online pre-meeting survey regarding degarelix administration and injection site reactions was conducted to gather insights from 11 international specialist nurses. Survey results supported the development of 25 best practice consensus statements for the in-person Delphi meeting (Warsaw, Poland), attended by 15 international specialist nurses. Statements focused on degarelix reconstitution, administration and patient care. Participants voted anonymously and collated responses were discussed after each voting round to understand if consensus could be achieved. If no consensus was reached after the first voting round, up to two more voting rounds were considered. Consensus was defined as “agreement” or “disagreement” by ≥75% of nurses, with ≤15% having the opposite opinion. In the pre-meeting survey, nurses reported that they observed injection site reactions in up to a third of treated patients after degarelix injection, and all agreed that the administration technique was, to some degree, related to the development of injection site reactions; a variety of materials were being used as guidance. In the Delphi study, consensus was reached on 5 of 9 statements related to reconstitution steps and 14 of 16 statements related to administration steps and patient care, all of which were considered to be important in the prevention of injection site reactions. This study confirmed country-specific variations in the degarelix administration technique and highlighted pivotal steps that may potentially contribute to injection site reactions. Importantly, all nurses agreed that technique optimisation holds the potential to reduce the occurrence of such reactions (“yes,” 45%; “possibly,” 55%; “no,” 0%). The findings should be considered along with other available materials and guidance to help reduce the risk of injection site reactions in patients with advanced prostate cancer treated with degarelix.