Delivery system for two or more autoinjectors

Abstract

Systems and methods are provided for first and second autoinjectors, each autoinjector including a housing body enclosing a prefilled syringe, a needle, a cap releasably attached to the housing body, and an injection spring configured to inject a medicament from the prefilled syringe. A housing may receive the housing body of each of the first and second autoinjectors. An outer cap may receive the cap of the first and second autoinjectors, where the outer cap is configured to remove the cap from the housing body of each of the first and second autoinjectors. In some embodiments, the first autoinjector and the second autoinjector are each configured to expel a fixed dose. In some embodiments, the outer cap is configured to remove the cap from the first autoinjector prior to removing the cap from the second autoinjector.

Description

DELIVERY SYSTEM FOR TWO OR MORE AUTOINJECTORSPriority

[0001] This application claims priority to U.S. Provisional Application No. 63 / 526,959, the entire disclosure of which is expressly incorporated herein by reference.Technical Field

[0002] The present disclosure relates generally to delivery systems for two or more autoinjectors.Background

[0003] An autoinjector is a device for automatically injecting a medicament into a patient. Autoinjectors have had rapidly increasing popularity' over recent years due to a variety of factors. For example, autoinjectors are convenient for both caregivers and for patients who self-administer predetermined fixed doses of medicament by decreasing the number of steps required to administer a medicament. Moreover, because autoinjectors are prefilled by suppliers of medicaments, there is no need to manually fill the syringe using vials of the medicament. The use of prefilled syringe can reduce the risk of errors in dosage, misidentification of the medicament, and contamination.Summary'

[0004] However, the present inventors recognize that the current autoinjectors can have deficiencies in large volume injections, for example, of greater than 2.5 milliliters. Large volume injections can take more than 10 seconds often necessitating an “on body” delivery' mechanism to address human factors such as holding the injector steady for that period of time. The large volume injectors can also create difficulty' with product design, for example in requiring stronger drive components. Furthermore, electromechanical solutions to large volume injections can greatly increase costs relative to purely mechanical solutions. One or more of the foregoing needs or other needs in the devices and systems described herein.

[0005] Thus, in one aspect, a system is provided having a first autoinjector including a first housing body enclosing a first prefilled syringe, a first cap releasably attached to the first housing body, a first needle, and a first injection spring configured to inject a first medicament from the first prefilled syringe through the first needle; a second autoinjector including a second housing body enclosing a second prefilled syringe, a second cap releasably attached to the second housing body, a second needle, and a second injectionspring configured to inject a second medicament from the second prefilled syringe through the second needle; a housing receiving the first housing body and the second housing body; and an outer cap receiving the first cap and the second cap, wherein the outer cap is configured to remove the first cap from the first housing body and the second cap from the second housing body.

[0006] In some embodiments, the system may include one or more of the following features. Each of the first autoinjector and the second autoinjector may be configured to expel a fixed dose. The first autoinjector and the second autoinjector may be identical. The housing may include an outer wall forming a sleeve around the first autoinjector and the second autoinjector. The outer wall may define one or more lumens that receives the first autoinjector and the second autoinjector. The outer wall may define a lumen that receives the first autoinjector and the second autoinjector. The lumen may define a first enlarged region receiving the first autoinjector, a second enlarged region receiving the second autoinjector, and a narrow region separating the first and second enlarged regions. The outer wall may include a first lobe around the first autoinjector and a second lobe around the second autoinjector, wherein the first lobe and the second lobe are separated by at least one longitudinal recess. The system may further include a third autoinjector having a third housing body enclosing a third prefilled syringe, a third cap releasably attached to the third housing body, and a third injection spring configured to inject a third medicament from the third prefilled syringe, wherein the housing receives the third autoinjector. The first autoinjector, the second autoinjector, and the third autoinjector may be in a triangular arrangement inside of the housing. The housing may have an open proximal end, and the first housing body and the second housing body extend proximally from the housing. The first autoinjector and / or the second autoinjector may have at least one label, and the at least one label may be visible from outside of the housing. The first autoinjector may include: a first cover sleeve extending from the first housing body, and a first cover sleeve spring configured to bias the first cover sleeve over the first needle, wherein pressing the first cover sleeve is configured to release the first injection spring. The second autoinjector may include: a second cover sleeve extending from the second housing body, and a second cover sleeve spring configured to bias the second cover sleeve over the second needle, wherein pressing the second cover sleeve is configured to release the second injection spring.Removing the outer cap may expose at least a distal portion of the first cover sleeve and at least a distal portion of the second cover sleeve. The first cover sleeve and the second cover sleeve may extend distally from the housing. The outer cap may be configured to remove thefirst cap from the first autoinjector prior to removing the second cap from the second autoinjector. The outer cap may include a first ledge configured to engage the first cap to pull the first cap from the first autoinjector, and a second ledge configured to engage the second cap to pull the second cap from the second autoinjector, where the second ledge is longitudinally offset of the first ledge. The outer cap may include a first groove proximal of the first ledge and configured to receive a first radial projection of the first cap. and a second groove proximal of the second ledge and configured to receive a second radial projection of the second cap, where the second groove has a longitudinal length longer than a longitudinal length of the first groove. The housing may have a closed proximal end configured to transfer a distal force applied to the housing to the first and second autoinjectors so as to simultaneously initiate an injection from the first and second autoinjectors. The first prefilled syringe may contain a first medicament, and the second prefilled syringe may contain a second medicament that is the same as the first medicament. The first prefilled syringe may contain a first medicament, and the second prefilled syringe may contain a second medicament that is different than the first medicament.

[0007] In another aspect, a system is provided for packaging a first injector and a second injector. The system may include a housing configured to receive the first autoinjector and the second autoinjector; and an outer cap configured to receive a first cap of the first autoinjector and a second cap of the second autoinjector. The outer cap may include a first ledge configured to engage the first cap to pull the first cap from a first housing body of the first injector; and a second ledge configured to engage the second cap to pull the second cap from a second housing body the second injector, where the second ledge is longitudinally offset of the first ledge.

[0008] In some embodiments, the system may include one or more of the following features. The outer cap may extend over a distal portion of the housing. The first ledge may be configured to extend at least partially around the first cap, and the second ledge is configured to extend at least partially around the second cap. The outer cap may include: a first groove proximal of the first ledge and configured to receive a first radial projection of the first cap; and a second groove proximal of the second ledge and configured to receive a second radial projection of the second cap, where the second groove has a longitudinal length longer than a longitudinal length of the first groove.

[0009] In yet another aspect, a system is provided having a first autoinjector having a first housing body coupled to a first cap; a second autoinjector having a second housing body coupled to a second cap; a housing receiving the first housing body and second housing body;and an outer cap receiving the first cap and the second cap. The outer cap may include: a first ledge configured to engage the first cap to pull the first cap from the first housing body; and a second ledge configured to engage the second cap to pull the second cap from the second housing body, where the second ledge is longitudinally offset of the first ledge.

[0010] In some embodiments, the system may include one or more of the following features. The first autoinjector may include a first prefilled syringe containing a first medicament, and the second autoinjector may include a first prefilled syringe containing a first medicament.

[0011] In even another aspect, a method is provided of removing a first cap from a first injector and a second cap from a second injector with an outer cap. The method may include moving the outer cap a first distance to pull the first cap from a first housing body of the first autoinjector without pulling the second cap; and subsequently moving the outer cap a second distance to pull the second cap from a second housing body of the second autoinjector.

[0012] In some embodiments, the method may include one or more of the following features. The first cap may have a first radial projection received in a first groove of the outer cap, and moving the outer cap the first distance may include pulling the first radial projection with a first ledge on a distal end of the first groove. The second cap may have a second radial projection received in a second groove of the outer cap, and moving the outer cap the first distance may include sliding the second radial projection through the second groove without pulling the second cap. The first autoinjector and the second autoinjector may be received in a housing. A distal portion of the housing may be received in the outer cap, and moving the outer cap the first distance may pull the outer cap distally from the housing.Brief Description of the Drawings

[0013] In order that the disclosure may be readily understood, aspects of this disclosure are illustrated by way of examples in the accompanying drawings.

[0014] FIG. 1 A illustrates a first embodiment of a delivery system for two or more autoinjectors.

[0015] FIG. IB illustrates a second embodiment of a delivery system for two or more autoinjectors.

[0016] FIG. 1C illustrates a third embodiment of a delivery system for two or more autoinjectors.

[0017] FIGS. 2A-D illustrate a method of uncapping the delivery system of FIG. 1A.

[0018] FIG. 3 illustrates a method of actuating the delivery system of FIG. IB.

[0019] FIG. 4 illustrates an exploded view of an embodiment of an autoinjector of the delivery system of any one of the delivery systems of FIGS. 1A-C.

[0020] FIG. 5 illustrates the autoinjector of FIG. 4 in a pre-inj ection configuration.

[0021] FIG. 6 illustrates the autoinjector of FIGS. 4 and 5 in a post-injection configuration.

[0022] The same reference numbers are used in the drawings and the following detailed description to refer to the same or similar parts.Detailed Description

[0023] The present disclosure is generally directed to delivery' systems for two or more injectors or autoinjectors. The systems may provide a simple, compact design for large volume injections and / or simultaneous injection of two or more medicaments. A plurality of autoinjectors may increase the surface area of the injection to improve absorption.Furthermore, simultaneous injection may facilitate mixing at the injection site underneath the skin for two or more medicaments that are not easily mixed prior to injection and / or need to be stored separately. Another advantage includes reduced injection times compared to a single large volume injection due to the parallel delivery. The system may include a uniform, monolithic housing that is easy to handle, facilitates manufacturing, and / or can be used with off-the-shelf autoinjectors. The system may have features that reduce the force necessary ■ to uncap the autoinjectors further improving handling. Even furthermore, the autoinjectors of the system may be single-use, fixed dose autoinjectors (non-user settable) to deliver a predetermined amount of medicament and to be easily actuated by users having minimal dexterity.

[0024] Except when otherwise indicated, the term “distal'’ or “distally’" refers to an orientation of the injection system or a respective component closer to an injection site as intendedly used. The term “proximal” or “proximally” refers to a position of the injection system or the component closer to an end opposite of the injection site as intendedly used. The term “axial” or “axially"’ refers to a length or direction that is along or parallel to a longitudinal axis of the injection system or the component. The term “radial"’ or “radially” refers to a length or direction perpendicular to the longitudinal axis of the injection device or the component. The term “circumferential” or “circumferentially” refers to a length or direction extending at least partially around the longitudinal axis of the injection system or the component.

[0025] FIG. 1A illustrates an embodiment of a delivery system 100 for tyvo or more autoinjectors 200. The delivery system 100 may include a first autoinjector 200a, a secondautoinjector 200b, a housing 120 holding the first and second autoinjectors 200a, b, and an outer cap 140 enclosing distal ends of the first and second autoinjectors 200a, b. The delivery system 100 may include any number of the autoinjectors (generally indicated as reference 200). For example, FIG. 1C illustrates another embodiment of the delivery system 100” having three autoinjectors 200 (not shown) held in a triangular configuration. However, the delivery systems 100, 100', 100” may include any number of configurations to hold two or more autoinjectors 200, such as a linear configuration and a zig-zag configuration.

[0026] The housing 120 may include a tubular body or sleeve formed by an outer wall 121 continuously extending circumferentially around at least a longitudinal portion of a housing body 220a, b of the plurality of autoinjectors 200a, b. However, in alternative embodiments (not shown), the autoinjectors 200a, b may snap in from a side of the housing 120, in that that the housing 120 may not fully circumferentially enclose any longitudinal portion of each autoinjector 200a, b such as in an embodiment where the housing 120 is formed with a w- shaped axial cross-section. The outer wall 121 may have one or more lumens 122 configured to receive the plurality of autoinjectors 200a, b. The one or more lumens 122 may or may not completely enclose at least a longitudinal portion of the housing body 220a, b (as previously discussed). As illustrated in FIG. 1A, the outer wall 121 may define a single, continuous lumen 122 receiving the plurality7of autoinjectors 200a, b. In an embodiment, the continuous lumen 122 may have a first enlarged region 122a configured to receive an autoinjector 200a, a second enlarged region 122b configured to receive another autoinjector 200b, and a narrow region 122c separating the first and second enlarged regions 122a, b. The first and second enlarged regions 122a, b may be shaped substantially complementary7to the housing body 220a, b of the autoinjectors 200a, b, respectively. The narrow region may be sized so as to separate the autoinjectors 200a, b and substantially prevent the autoinjectors 200a, b from translating between the first and second enlarged regions 122a, b. However, the outer wall 121 may alternatively define a plurality of lumens separated by interior walls (not shown) individually receiving the autoinjectors 200a, b. The housing 120 may hold the autoinjector 200a. b longitudinally fixed inside of the one or more lumens 122 during administration.However, in some embodiments, the housing 120 may allow some longitudinal translation of the autoinjector 200a, b via a backing spring or elastic component (not shown) to accommodate curvature of the skin so that all of the autoinjector 200a, b contact the body curvature to inject to the same depth.

[0027] The one or more lumens 122 may have an open proximal end, where the autoinjectors 200a, b extend proximally from the housing 120, as illustrated in FIG. 1 A. The one or morelumens 122 may alternatively have a closed proximal end, such that the proximal portions of the autoinjectors 200 are contained within the housing 120, as illustrated in the delivery systems 100’, 100” of FIGS. IB, C. Thus, the outer wall 121’, 121” may extend proximally to a proximal wall 126’, 126” at least partially closing the proximal end of the housing 120’, 120”. At least a portion of the outer wall 121 may be transparent and / or translucent. For example, the entirety of the outer wall 121 may be of a transparent and / or translucent material to enable full visibility of the autoinjectors 200. Additionally or alternatively, the outer wall 121 may have one or more windows 125 aligned with a window of each of the autoinjectors 200a, b for visibility of the medicament(s) in the autoinjectors 200a, b and to enable external monitoring of injection progress. The window 125 of the outer wall 121 and / or the autoinjectors 200a. b may be formed by an opening and / or a transparent and / or translucent material enabling visibility. In some embodiments, the housing 120 may include a mirror and / or a lens system to improve visibility of the medicament(s) and / or at least one sensor for electronically monitoring the medicament(s) and / or autoinjectors 200. One or more of the autoinjectors 200a. b may include at least one label 250 that is visible from outside of the housing 120. 120’. 120” by the user, e.g.. for drug verification. For example, as illustrated in FIG. 1 A, the at least one label 250 may be proximal of the open proximal end of the housing 120 to enable visibility' of the at least one label 250. In some embodiments, the housing 120, 120’, 120” may, additionally or alternatively, have one or more transparent and / or translucent portions and / or windows (not shown) aligned with the at least one label to enable visibility. The at least one label may include information on the autoinjector 200 and / or the medicament(s) in the respective autoinjector 200, such as a name, a formulation, a tradename, a manufacturer, an expiration date, instructions for use (IFU), an intended site of injection, a web address, a barcode, and / or a quick-response (QR) code. The at least one label may be printed and / or adhered onto the respective autoinjector 200.

[0028] The housing 120 and / or outer cap 140 may be single use or re-useable components. For example, embodiments of the delivery' system 100 having an open proximal end may enable removal and replacement of the autoinjectors 200 from the open proximal end of the housing 120 after use of the auto injectors 200. Embodiments of the delivery system 100’, 100” having a closed proximal end may prevent removal of the autoinjectors 200, thus the housing 120 may be disposed of with the autoinjectors 200 after use. Further, when the distal ends of the autoinjectors 200 are placed against an injection site, the closed proximal end may transfer a distal force applied to the system 100’, 100” to each of the autoinjectors 200 to simultaneously initiate injection for each of the autoinjectors 200.

[0029] The housing 120 may be a single unitary, monolithic body without any moving parts, and the delivery system 100 may be without any rotating external parts such as dosing mechanisms and / or gears. This configuration may simplify manufacturing and improve handling by providing a compact unit without the possibility of inadvertent dosing or actuation when the delivery7system 100 is capped. The housing 120 may further facilitate ergonomics, set an optimal position of the autoinjectors 200a.b. prevent longitudinal translation of the autoinjectors 200a, b, optimize dose window visibility, and / or optimize removal of the outer cap 140.

[0030] The tubular body or sleeve formed by the outer wall 121 may facilitate grasping and handling by users with minimal dexterity, similar to handling of the autoinjectors 200 individually. For example, the housing 120 may be grasped by a user between a forefinger, a middle finger, and a thumb to hold a wider dimension (see FIG. 3) or a narrower dimension transverse to the wider dimension. Further, for the system 100, 100’, 100” a user can initiate injection for each autoinjector by imparting a distal force on the closed proximal end, such as by with a palm. The housing 120 may have a substantially uniform cross-section along its longitudinal length to form a minimal profile and approximate the outer surface of the housing body 220 of the autoinjectors 200. The housing 120 may include one or more textured or ribbed portions on the outer surface to assist gripping. The outer surface of the housing 120 may additionally or alternatively, have any number of cross-sections, such as oval, circular, square, rectangular, and combinations thereof.

[0031] As illustrated in FIGS. 1 A-C, the cross-section of the housing 120 may be formed by a plurality of lobes 123, with each lobe 123 accommodating one of the autoinjectors 200 (via the first or second enlarged regions 122a, 122b). In the delivery' system 100”, there may be a third enlarged region (not labeled). Each of the lobes 123 may form convex side portions extending greater than 180 degrees around the autoinjector 200, depending on the number of autoinjectors 200 in the housing 120. The lobes 123 may be externally separated by at least one longitudinal recess 124 forming concave or flat side portions. For example, as illustrated in FIGS. 1A-B, the outer wall 121 may have two longitudinal recesses 124 on opposite lateral sides of the housing 120 separating two lobes 123. As illustrated in FIG. 2, the outer wall 121 may have three longitudinal recesses 124 separating three lobes 123 in a circumferential painvise manner. The lobes 123 and / or longitudinal recesses 124 may extend substantially the entire length of the housing 120. The housing 120 may have symmetry relative to a longitudinal plane extending along a major lateral axis (e.g, extending through the two lobes 123 of FIG. 1A) and a minor lateral axis (e.g., extending between the two lobes 123 of FIG.1A). Longitudinal symmetry is also evident in the housing 120” of FIG. 1C relative to a plane that extend through each of the lobes 123’ and between the other lobes 123”. Further, each of the lobes 123 may be internally separated by a narrow region 122c, as shown in FIG. 1A.

[0032] The lobes 123 and longitudinal recesses 124 may improve handling and / or secure the first and second autoinjectors 200a, b in place. For example, the concavity of the longitudinal recesses 124 may provide a surface with improved gripping. Furthermore, the width formed by the more longitudinal recesses 124 may be less than a width of the autoinjectors 200, and the housing 120 may be resiliently flexible (e.g., a plastic) to frictionally secure the autoinjectors 200 in place in a press fit by compression against the outer surface of the autoinjectors 200. Additionally or alternatively, the housing 120 may include crush ribs including one or more small raised fins of plastic that are crushed by the autoinjectors 200 creating enough friction to make it difficult to remove by hand. This frictional securement may enable the housing 120 to retain off-the-shelf autoinjectors 200 of different sizes without modification. Additionally or alternatively, the autoinjectors 200 may be secured inside the housing 120 with a snap engagement, a latching mechanism, an adhesive, and / or a weld (not shown). Additionally or alternatively, the housing 120 may be assembled by attaching circumferential portions of the housing 120 together (e.g, two housing halves) around the autoinjectors 200 a, b by screws, heat stake, ultrasonic welding, etc. The distal end of the housing 120 may be open, and distal portions of the autoinjectors 200 may extend distally out of the distal end of the housing 120 exposing the cover sleeves 226a, b for injection of the medicament(s).

[0033] The outer cap 140 may be initially disposed around the distal portions of the autoinjectors 200. An inner surface of the outer cap 140 may approximate the cross-section of the outer surface of the housing 120. The outer cap 140 may receive a distal portion of the housing 120 in a press, frictional, or interference engagement to retain the delivery system 100 in a capped configuration, as illustrated in FIG. 2A.

[0034] FIGS. 2A-D illustrate a method of uncapping the autoinjectors 200a, b with the system 100. The user may initially obtain a sealed package including the system 100’ as assembled in FIGS. 1 A-C, and the user may remove the system 100’ from the package. As illustrated, the method of uncapping may include pulling the outer cap 140 away from the housing 120 to first remove a first cap 228a from the first housing body 220a and then remove a second cap 228b from the second housing body 220b. In some embodiments, the first cap 228a may be initially retained on a first radial protrusion 221a on a distal portion ofthe first housing body 220a, and the second cap 228b may be initially retained on a second radial protrusion 221b on a distal portion of the first housing body 220b. The radial protrusions 221a, b may retain the caps 228a, b through a press, frictional, or interference fit, such that an initial longitudinal separation force is required to disengage the cap 228a, b, from the housing body 220a, b. The initial separation force is substantially greater than the force required to further pull the cap 228a, b from the housing body 220a, b. Thus, an additive initial separation force required to simultaneously separate the first cap 228a from the first radial protrusion 221a, the second cap 228b from the second radial protrusion 221b, and in some embodiments additional caps 228 of additional autoinjectors 200 in the delivery’ system 100 would be difficult for some users, especially those with poor dexterity. Therefore, the method of FIGS. 2A-D may provide a staged, serial uncapping of the autoinjectors 200a, b such that the initial separation forces are spread out over time and not additive, reducing the force required to uncap the autoinjectors 200a, b. However, in some embodiments, the cap 228a, b may not contact the respective housing body 220a, b and only be retained by contact with a needle shield (not shown).

[0035] As illustrated in FIG. 2A, the outer cap 140 may axially engage the first cap 228a prior to the second cap 228b. As further illustrated in FIGS. 2B, the outer cap 140 may be pulled from the housing 120 to initially disengage and pull the first cap 228a from the first radial protrusion 221a of the first housing body 220a without disengaging or pulling the second cap 228b from the second radial protrusion 221b. The pulling of the first cap 228a may be performed by the first cap 228a having a first radial projection 229a being received in a first groove of the outer cap 140. The first groove may be defined by a longitudinal space between a first ledge 142a and a distal interior surface 144 of the outer cap 140. The first ledge 142a may pull the first radial projection 229a to separate the first cap 228a from the first housing body 220a. The first ledge 142a may extend at least partially around a longitudinal axis of the first cap 228a to engage a circumference of the first radial projection 229a and prevent the first cap 228a from tilting as the outer cap 140 is pulled. The outer cap 140 may. additionally or alternatively, include an additional grasping member, such as a pull ring and / or a handle.

[0036] As illustrated in FIGS. 2B, the outer cap 140 may be moved a first distance to remove the first cap 228a from the first housing body 220a prior to initially disengaging or pulling the second cap 228b from the second housing body 220b. Thus, the disengagement of the second cap 228 from the second radial protrusion 221b may be performed after the first cap 228a is disengaged from the first radial protrusion 221a. The removal of the second cap 228b may beperformed by the second cap 228b having a second radial projection 229b being received in a second groove of the outer cap 140. The second groove may be defined by a longitudinal space between a second ledge 142b and the distal interior surface 144 of the outer cap 140. The second ledge 142b may extend at least partially around a longitudinal axis of the second cap 228b to engage a circumference of the second radial projection 229b and prevent the second cap 228b from tilting as the outer cap 140 is pulled. The second ledge 142b may be longitudinally offset of the first ledge 142a. For example, the second ledge 142b may be proximal of the first ledge 142a, such that the second groove has a longitudinal length longer than a longitudinal length of the first groove. Thus, the second radial projection 229b may longitudinally slide through the second groove, as the outer cap 140 is initially pulled and the first cap 228a is removed or initially disengaged from the first housing body 220a. After the second radial projection 229b reaches the second ledge 142b, the outer cap 140 may begin to pull the second cap 228b. As illustrated in FIGS. 2B-C, the second ledge 142b may pull the second radial projection 229b to initially disengage the second cap 228b from the second radial protrusion 221b of the second housing body 220b.

[0037] As further illustrated in FIG. 2D. continuing to pull the outer cap 140 distally from the housing 120 may simultaneously pull the first cap 228a and the second cap 228b to completely uncap the first autoinjector 200a and the second autoinjector 200b. Removing the first cap 228a may expose at least a distal portion of a first cover sleeve 226a, and removing the second cap 228b may expose at least a distal portion of a second cover sleeve 226b. The first autoinjector 200a and the second autoinjector 200b may then be applied to an injection site to inject the medicament(s), as illustrated in FIG. 3.

[0038] Although the method of FIGS. 2A-D is illustrated with the sy stem 100 of FIG. 1, the method illustrated in FIG. 2A-D may be readily implemented with the system 100' or the system 100”. For example, the method of FIGS. 2A-D may serially uncap three or more autoinjectors 200 having three or more ledges 142 at different longitudinal positions such that disengagement of the caps 228 from the radial protrusions 221 is not additive. The ledges 142 may be in the form of hooks, steps, and / or undercuts.

[0039] FIG. 3 illustrates a method of applying the system 100’ by a user to an injection site after removing the outer cap 140’. The user may handle the first and second autoinjectors 200a’, b’ by grasping the housing 120’ and align the first and second autoinjectors 200a, b with the injection site. The user may press the distal portion of the sy stem 100’ against skin at the injection site to simultaneously move the first and second cover sleeves 226a, b into the housing bodies 220a, 220a. The first and second autoinjectors 200a, b may thensimultaneously inject the medicament(s) into the body, as further discussed below. Although illustrated with the system 1 OCT of FIG. 2. the method illustrated in FIG. 3 may be readily performed with the system 100 or the system 100”.

[0040] As used herein, the term '‘medicament(s)” refers to any biologically active or drugcontaining flowable substance, such as a liquid, solution, or fine suspension. Representative drugs include pharmaceuticals such as peptides, proteins (e.g., insulin, insulin analogues, and C-peptides), and hormones, biologically derived or active agents, hormonal and gene-based agents, nutritional formulas, and other substances in both solid (dispensed) or liquid form. The medicament(s) may be used to treat or prevent migraine headaches as well as other diseases, conditions, chronic illnesses and disabilities, and other therapeutic purposes.

[0041] In some embodiments, the first autoinjector 200a may contain a first medicament, and the second autoinjector 200b may contain a second medicament different than the first medicament. The system 100 may provide the advantage of avoiding long-term storage of a mixed solution of the first and second medicaments that can compromise stability and / or therapeutic performance. The first medicament and second medicament may be mixed underneath the skin at the injection site after injection. However, in some embodiments, the system may include a small mixing chamber (not shown), and the autoinjectors 200a, b may inject the respective medicament into the mixing chamber and the resultant mixture may flow throw a single needle into the skin. The system 100 may also avoid the user from having to mix the medicaments prior to injection, which may be burdensome and / or compromise safety, or utilize a more complicated injection apparatus that enables mixing during injection. The system 100 may be configured to treat two diseases that have known genetic or predisposed links with separate medicaments. For example, some diseases carry an increased likelihood of people having an additional autoimmune disease. These include rheumatoid arthritis, multiple sclerosis, autoimmune thyroiditis, Sjogren’s syndrome and others. Some diseases occur together more frequently, such as type 1 diabetes and celiac, because of a shared gene that predisposes for these diseases. In some embodiments, the first medicament and the second medicament may be the same, and still provide the advantage of reduced injection time.

[0042] The first medicament and the second medicament may be different types of insulin and / or insulin inducers in amounts and proportions tailored to the user. For example, the first medicament may be a long-acting insulin and the second medicament may be a glucagon-like peptide-1 (GLP-1) that enhances natural insulin secretion through mechanisms involving the regulation of ion channels.

[0043] Insulin may include insulin analogs, insulin derivatives or mixtures thereof, including human insulin or a human insulin analogs or derivatives. Examples of insulin analogs are, without limitation, Gly(A21), Arg(B31), Arg(B32) human insulin; Lys(B3), Glu(B29) human insulin; Lys(B28), Pro(B29) human insulin; Asp(B28) human insulin; human insulin, wherein proline in position B28 is replaced by Asp, Lys, Leu, Vai or Ala and wherein in position B29 Lys may be replaced by Pro; Ala(B26) human insulin; Des(B28-B30) human insulin;Des(B27) human insulin or Des(B30) human insulin. Examples of insulin derivatives are, without limitation, B29-N-myristoyl-des(B30) human insulin; B29-N-palmitoyl-des(B30) human insulin; B29-N-myristoyl human insulin; B29-N-palmitoyl human insulin; B28-N- myristoyl LysB28ProB29 human insulin; B28-N-palmitoyl-LysB28ProB29 human insulin; B30-N-myristoyl-ThrB29LysB30 human insulin; B30-N-palmitoyl-ThrB29LysB30 human insulin; B29-N — (N-palmitoyl-Y-glutamyl)-des(B30) human insulin; B29-N — (N- lithocholyl-Y-glutamyl)-des(B30) human insulin; B29-N-(co-carboxyheptadecanoyl)- des(B30) human insulin and B29-N-(oi-carboxyhepta-decanoyl) human insulin.

[0044] GLP-1 may include GLP-1 analogs, or mixtures thereof, including without limitation, exenatide (Exendin-4(l-39). a peptide of the sequence H-His-Gly-Glu-Gly-Thr-Phe-Thr-Ser- Asp-Leu-Ser-Lys-Gln-Met-Glu-Glu-Glu-Ala-Val-Arg-Leu-Phe-Ile-Glu-Trp-Leu-Lys-Asn- Gly-Gly-Pro-Ser-Ser-Gly-Ala-Pro-Pro-Pro-Ser-NH2), Exendin-3, Liraglutide, or AVE0010 (H-His-Gly-Glu-Gly-Thr-Phe-Thr-Ser-Asp-Leu-Ser-Lys-Gln-Met-Glu-Glu-Glu-Ala-Val- Arg-Leu-Phe-Ile-Glu-Trp-Leu-Lys-Asn-Gly-Gly-Pro-Ser-Ser-Gly-Ala-Pro-Pro-Ser-Lys-Lys- Lys-Lys-Lys-Lys-NH2).

[0045] Other medicaments or medicament combinations may, additionally or alternatively, include analgesics, hormones, beta agonists, and / or corticosteroids, or a combination of any of the medicaments as discussed herein.

[0046] In an example, the first medicament may be a long-acting muscarinic antagonist (LAMA), and the second medicament may be a long-acting beta antagonist (LABA) combined to treat chronic obstructive pulmonary7disease (COPD). In yet another example, the first medicament may be a corticosteroid, and the second medicament can be one of the LAMA or LABA to enhance the efficacy of the corticosteroid.

[0047] Examples of beta agonists are, without limitation, salbutamol, levosalbutamol, terbutaline, pirbuterol, procaterol, metaproterenol, fenoterol, bitolterol mesylate, salmeterol, formoterol, bambuterol, clenbuterol, indacaterol.

[0048] Hormones may be for example hypophysis hormones or hypothalamus hormones or regulatory active peptides and their antagonists, such as Gonadotropine (Follitropin,Lutropin, Choriongonadotropin, Menotropin), Somatropine (Somatropin), Desmopressin, Terlipressin, Gonadorelin, Triptorelin. Leuprorelin, Buserelin, Nafarelin. Goserelin.

[0049] In other illustrative examples, the first medicament and the second medicament may be separate sealing components that may mixed to reduce bleeding and / or seal a biopsy or a puncture tract. For example, the first medicament may include, for example, at least two N- hydroxysuccinimide (NETS) ester groups, and the second medicament may include, for example, at least two amine groups. The first medicament may be a solution containing polyethylene glycol (PEG) succinimidyl succinate and the second medicament may be a solution containing albumin and / or polyethylenimine (PEI). In other embodiments, the first medicament may include a polymerizable agent (e.g., fibrinogen) and the second medicament may include an initiator or an accelerator (e.g., thrombin). The sealing components may be mixed either in a mixing chamber or at the injection site to seal tissue.

[0050] FIGS. 4-6 illustrate an exemplary embodiment for each of the autoinjectors 200 as illustrated in FIGS. 1-3. FIG. 4 illustrates components of the autoinjector 200 in an exploded view. FIG. 5 illustrates the autoinjector 200 in a pre-inj ection configuration, and FIG. 6 illustrates the autoinjector 200 in a post-injection configuration. The two or more autoinjectors 200 of the system 100, 100’, 100” may be identical, for example, having the same make and model. Although an exemplary' embodiment of the autoinjector 200 is disclosed and illustrated herein, other suitable injectors and autoinjectors may be used with the system 100 and methods disclosed herein. However, as further discussed below, the autoinjector 200 may be single-use and non-user settable, configured to deliver a predetermined or fixed dose. Thus, the autoinjector 200 would not have any dose setting mechanisms actuated by the user, being easily usable by users with minimal dexterity'.

[0051] The autoinjector 200 may have a distal portion 210 and a proximal portion 212. The autoinjector 200 may be actuated by pushing the distal portion 210 against skin of a patient at an injection site, as illustrated in FIG. 3. The autoinjector 200 may be held at the injection site until a volume of a medicament 202 has been expelled from a prefilled syringe 201 into the injection site. The prefilled syringe 201 may include a syringe barrel 204 enclosing the medicament 202. The syringe barrel 204 may be in communication with a needle 206 at a distal end and be sealed by a stopper 208 at a proximal end. The needle 206 may be integrally attached to the syringe barrel 204 or placed in communication with the syringe barrel 204 upon initiation of an injection.

[0052] The autoinjector 200 may have a housing body 220 and an end cap 222 mounted at a proximal portion of the housing body 220. The autoinjector 200 may also have a syringeholder 224 disposed within the housing body 220 configured to hold the prefilled syringe 201. The syringe holder 224 and the end cap 222 may be fixed stationary’ to the housing body 220.

[0053] A cover sleeve 226 may be mounted at a distal portion of the housing body 220. The cover sleeve 226 may be telescopically slidable relative to the housing body 220 between an extended position (see FIG. 5) and a retracted position (see FIG. 6). When in the extended position, at least a distal portion of the cover sleeve 226 extends out of the housing body 220 and surrounds the needle 206 of the prefilled syringe 201 to prevent inadvertent puncturing. Moving the cover sleeve 226 to the retracted position may expose the needle 206 for injection of the medicament 202.

[0054] A cover sleeve spring 230 may extend between a first end 230a and a second end 230b. The cover sleeve spring 230 may bias the cover sleeve 226 to the extended position and be compressed when the cover sleeve 226 is depressed to the retracted position. As illustrated, the cover sleeve spring 230 may be a helical coil spring, but the cover sleeve spring 230 may alternatively embody a gas-powered spring, a pneumatic spring, a hydraulic spring, or any other type of spring.

[0055] A cap 228 may be initially disposed over the cover sleeve 226 and engage the housing body 220. For example, the cap 228 may be releasably retained by a press, frictional, and / or interference fit, e.g, onto a radial protrusion 229 on the distal portion of the housing body 220. The cap 228 may retain and inhibit movement of the cover sleeve 226 when the cap 228 on the distal portion of the housing body 220. The cap 228 may also grip a rigid needle shield (not shown) that is initially disposed over the needle 206 of the prefilled syringe 201. The cap 228 may entrain and remove the rigid needle shield from the needle 206 when removed from the autoinjector 200. Removal of the cap 228 may be through radial deflection of the cap 228 and / or the radial protrusion 229 to remove the press, frictional, and / or interference fit between the cap 228 and the housing body 220. A user may remove the cap 228 (and thus the rigid needle shield) by gripping the cap 228 and pulling the cap 228 distally.

[0056] A support member 232 may be disposed within the housing body 220 proximal of the syringe holder 224. The support member 232 may be axially and rotationally fixed to the end cap 222.

[0057] A drive assembly may be disposed w ithin the housing body 220 proximal of the syringe holder 224. The drive assembly may include an injection spring 234 and a subassembly biased by the injection spring 234. As illustrated, the injection spring 234 maya helical coil spring; however, the injection spring 234 may alternatively embody a conical spring, a torsion spring, a gas-powered spring, a pneumatic spring, a hydraulic spring, or any other structure that biases the drive assembly toward the distal portion 210 of the autoinjector 200.

[0058] The drive or subassembly may include a piston rod 236 aligned with the stopper 208 of the prefilled syringe 201. The piston rod 236 may be axially movable within the housing body 220 along a travel distance between a cocked position (see FIG. 5) and a bottomed-out position (see FIG. 6). When in the cocked position, the piston rod 236 may be proximally spaced from the stopper 208, such that the injection spring 234 would not apply a dispensing force against the stopper 208 immediately upon release and expansion of the injection spring 234. When released, the injection spring 234 may decompress slightly and advance the piston rod 236 a short distance until the piston rod 236 engages the stopper 208. Once the piston rod 236 engages the stopper 208, the injection spring 234 may continue to extend until the piston rod 236 reaches the bottomed-out position and presses the stopper 208 against the proximally facing shoulder of the prefilled syringe 201. Thus, the injection spring 234 may have a first length in the cocked position and a second length when the piston rod 236 is disposed in the bottomed-out position, where the second length is greater than the first length.

[0059] The subassembly may include a holding pin 238 configured to releasably hold the piston rod 236 in an axially fixed position against the bias of the injection spring 234. The injection spring 234 may be sandwiched between the piston rod 236 and the holding pin 238. The holding pin 238 may be biased proximally towards the end cap 222 by the injection spring 234. The second end 234b of the injection spring 234 may push against an inner shoulder of the holding pin 238. The holding pin 238 may have a locking configuration and a releasing configuration. In the locking configuration, the holding pin 238 may engage the piston rod 236 to hold or axially fix the piston rod 236 in the cocked position relative to the holding pin 238 against the bias of the injection spring 234. In the releasing configuration, the holding pin 238 may release the piston rod 236 to enable relative movement between the piston rod 236 and the holding pin 238.

[0060] The holding pin 238 of the drive assembly may have arms 238a extending from a fixed end 238d to a free end 238c. The fixed ends 238d may be attached at a base portion 238e. The free ends 238c may define stop members 238b that move radially when the arms 238a are flexed. In some embodiments, the base portion 238e may be sized to extend through the injection spring 230 and into the piston rod 236.

[0061] The piston rod 236 may define a plurality of recesses 236a configured to seat the stop members 238b of the holding pin 238. Accordingly, the holding pin 238 is disposed in the locking configuration when the arms 238a are flexed radially inwardly so that the stop members 238b engage the recesses 236a to retain the piston rod 236 in the cocked position. The holding pin 238 transitions to the releasing configuration when the arms 238a flex radially outwardly to move the stop members 238b away from the recesses 236a

[0062] A holding sleeve 240 may surround a portion of the holding pin 238. The holding sleeve 240 may be configured to move axially between a distal position (see FIG. 5) and a proximal position (see FIG. 6). When in the distal position, the holding sleeve 240 retains the holding pin 238 in the locking configuration. In particular, the holding sleeve 240 radially aligns with the arms 238a and has a sufficiently small inner cross-dimension to inhibit outward radial flexing of the arms 238a. Accordingly, the holding sleeve 240 inhibits outward radial movement of the stop members 238b of the holding pin 238 from the recesses 236a of the piston rod 236. When in the proximal position, the holding sleeve 240 may be axially offset from the stop members 238b, thereby allowing the holding pin 238 to transition to the releasing configuration.

[0063] The holding sleeve 240 may be biased to the distal position by the cover sleeve spring 230. A first end 230a of the cover sleeve spring 230 may abut the holding sleeve 240, which may abut a proximal portion of the cover sleeve 226. Movement of the cover sleeve 226 to the retracted position may push the holding sleeve 240 to the proximal position and compress the cover sleeve spring 230 to the second length. The holding sleeve 240 may have a telescopic configuration. For example, the holding sleeve 240 may include an outer body 240a and an inner body 240b (see FIG. 6). The inner body 240b may be disposed around the support member 232. The inner body 240b may be rotationally fixed to, but axially movable relative to the support member 232. The outer body 240a may be disposed around the inner body 240b. The outer body 240a and inner body 240b may be rotationally fixed together. The outer body 240a and inner body 240b snap-fit to each other to move axially together as a unit from the distal position to the proximal position. For example, the inner body 240b may have a ramped tooth and the outer body 240a may define a slot sized to receive the ramped tooth. The ramped tooth extends through the slot to be entrained by the outer body 240a in the proximal direction. The ramped tooth cams out of the slot as the outer body 240a is moved distal of the inner body 240b.

[0064] An indicator sleeve 242 may be disposed within the housing body 220 proximal of the syringe holder 224. As will be described in more detail herein, interaction between theindicator sleeve 242 and other components within the housing body 220 may generate a noise (e.g., clicks) that audibly indicates stages of the injection (e.g., start of injection and end of injection). The indicator sleeve 242 may be axially movable relative to the housing body 220 between a proximal position and a distal position. For example, the indicator sleeve 242 may have wings 242b that slide in slots 232a defined in the support member 232 to limit axial movement between the indicator sleeve 242 and support member 232. The indicator sleeve 242 may be biased proximally by the cover sleeve spring 230. For example, the second end 230b of the cover sleeve spring 230 may abut a portion of the indicator sleeve 242. Accordingly, the cover sleeve spring 230 may be sandwiched between the holding sleeve 240 and the indicator sleeve 242, for example between the outer body 240a of the holding sleeve 240 and the wings 242b of the indicator sleeve 242.

[0065] The indicator sleeve 242 may limit axial movement of the holding pin 238 relative to the housing body 220. For example, the indicator sleeve 242 may have grooves in which the stop members 238b of the holding pin 238 ride during axial movement of the holding pin 238 between the respective distal and proximal positions. Engagement between the stop members 238b and the grooves may limit distal movement of the holding pin 238 relative to the indicator sleeve 242, which limits the distal movement of the holding pin 238 relative to the support member 232, which is axially fixed relative to the housing body 220.

[0066] The indicator sleeve 242 may selectively engage the piston rod 236. For example, the indicator sleeve 242 may have one or more arms 242c with detents 242d at the free ends. The arms 242c may flex to move the detents 242d radially relative to the piston rod 236, and the detents 242d may be sized to snap into corresponding slots 236c defined in the piston rod 236.

[0067] FIG. 5 illustrates the autoinjector 200 in a pre-inj ection configuration, with the cap 228 and rigid needle shield being removed. The stopper 208 is disposed at a first position within the prefilled syringe 201. The piston rod 236 is held at a location spaced proximally from the stopper 208 by the holding pin 238.

[0068] The holding pin 238 and piston rod 236 may be positioned relative to each other such that the stop members 238b of the holding pin 238 radially align with the recesses 236a of the piston rod 236. The holding sleeve 240 may be disposed in the distal position at which the inner body 240b of the holding sleeve 240 radially aligns with the stop members 238b of the holding pin 238. Accordingly, the holding sleeve 240 may press the stop members 238b into the recesses 236a and inhibits radial movement of the stop members 238b out of therecesses 236a The detents 242d of the indicator sleeve 242 may be disposed within the slots 236c of the piston rod 236. The inner body 240b of the holding sleeve 240 may radially align with the detents 242d. The inner cross-dimension of the inner body 240b of the holding sleeve 240 may be sufficiently small to retain the detents 242d within the slots 236c when radially aligned with the detents 242d.

[0069] An injection may be initiated by proximal movement of the cover sleeve 226 relative to the housing body 220 to the retracted position. When the distal portion 210 of the autoinjector 200 is pressed against an injection site, proximal movement of the cover sleeve 226 relative to the housing body 220 can be accomplished through a distal force applied to the autoinjector 200 (e g., the housing body 220 of the autoinjector 200) by the user. A proximal end of the cover sleeve 226 may abut the outer body 240a of the holding sleeve 240 and push the holding sleeve 240 to its proximal position. When in the proximal position, the holding sleeve 240 is not radially aligned with the stop members 238b of the holding pin 238. Accordingly, the bias of the injection spring 234 acting on the piston rod 236 is sufficient to cam the stop members 238b out of the recesses 236a in the piston rod 236.

[0070] Accordingly, the piston rod 236 may be free to move distally under the bias of the injection spring 234 towards the stopper 208 of the prefilled syringe 201. While moving distally, the piston rod 236 engages the stopper 208 of the prefilled syringe 201 and pushes the stopper 208 distally along the path of travel within the syringe barrel 204. Distal movement of the stopper 208 pushes the medicament 202 through the needle 206 at the distal end 152 of the prefilled syringe 201.

[0071] Releasing the stop members 238b from the recesses 236a of the piston rod 236 also frees the holding pin 238 for movement relative to the piston rod 236. In certain embodiments, the injection spring 234 may bias the holding pin 238 proximally towards the end cap 222. The stop members 238b of the holding pm 238 may engage the distal end of the inner body 240b of the holding sleeve 240. The holding pin 238 may entrain the inner body 240b of the holding sleeve 240 during this proximal movement until the inner body 240b abuts the support member 232. The impact between the inner body 240b of the holding sleeve 240 and the support member 232 may create a noise (e.g.. a first click) that provides an audible indication that injection has started. The stop members 238b may inhibit movement of the inner body 240b of the holding sleeve 240 back to the distal position. The stop members 238b do not engage the outer body 240a of the holding sleeve 240. Accordingly, the outer body 240a can move distally over the stop members 238b.

[0072] When the piston rod 236 begins moving distally, the piston rod 236 may entrain the indicator sleeve 242 via the engagement between the detents 242d and the slots 236c. Accordingly, the piston rod 236 may move the indicator sleeve 242 to the distal position against the bias of the cover sleeve spring 230. Engagement between the wings 242b of the indicator sleeve 242 and the support member 232 may prohibit further distal movement of the indicator sleeve 242.

[0073] When the indicator sleeve 242 is disposed in the distal position, the detents 242d may be axially offset from the holding sleeve 240 (see FIG. 6), which is disposed in the proximal position. Accordingly, the detents 242d may be free to cam out of the slots 236c of the piston rod 236, thereby allowing the piston rod 236 to continue being moved distally by the injection spring 234. When moved radially outwardly, the detents 242d may engage the distal end of the holding sleeve 240, thereby preventing proximal movement of the indicator sleeve 242. The body of the piston rod 236 prevents radially inward deflection of the arms 242c and detents 242d during injection.

[0074] The piston rod 236 may move the stopper 208 within the syringe barrel 204 until the stopper 208 bottoms out within the syringe barrel 204. The injection spring 234 may continue to press the piston rod 236 against the stopper 208 when the stopper 208 is disposed in the bottomed-out position.

[0075] After injection is complete, the autoinjector 200 may be moved away from the injection site 198, and the cover sleeve 226 may be biased distally over the needle 206, and the cover sleeve 226 may be locked in the extended position covering the needle 206. In particular, the cover sleeve spring 230 may bias the outer body 240a of the holding sleeve 240 distally. The outer body 240a may be locked from proximal movement by the inner body 240b. The outer body 240a may abut the cover sleeve 226 to prevent proximal movement of the cover sleeve 226 back to the retracted position. The stop members 238b of the holding pin 238 may prevent distal movement of the inner body 240b of the holding sleeve 240. Accordingly, the outer body 240a may be configured to move distally relative to the inner body 240b until the inner body 240b and outer body 240a axially lock relative to each other. For example, a detent on the inner body 240b may snap into a recess defined by the outer body 240a

[0076] Notches defined at the proximal end of the piston rod 236 may align with the detents 242d of the indicator sleeve 242 when the piston rod 236 reaches the bottomed-out position. The notches may allow the detents 242d to cam radially inwardly, thereby disengaging from the holding sleeve 240. Releasing the detents 242d from the holdingsleeve 240 frees the indicator sleeve 242 for movement back to the proximal position under the bias of the cover sleeve spring 230. The cover sleeve spring 230 may push the indicator sleeve 242 proximally against the end cap 222, which creates another noise (e.g., a second click) that provides an audible indication that injection has ended. An embodiment of the autoinjectors 200 is further described in U.S. Pat. 11,541,177 (titled “Injection spring for aged prefilled syringe and auto injector" and filed September 19, 2019), the entire disclosure of which is expressly incorporated herein in its entirety.

[0077] It will be appreciated by persons of ordinary skilled in the art that the present disclosure is not limited by what has been particularly shown and described hereinabove. Rather, the scope of the present disclosure includes both combinations and sub-combinations of various features described hereinabove as well as modifications and variations which would occur to persons skilled in the art upon reading the foregoing description.

Claims

What is claimed is:

1. A system comprising: a first autoinjector including a first housing body enclosing a first prefilled syringe, a first cap releasably attached to the first housing body, a first needle, and a first injection spring configured to inject a first medicament from the first prefilled syringe through the first needle; a second autoinjector including a second housing body enclosing a second prefilled syringe, a second cap releasably attached to the second housing body, a second needle, and a second injection spring configured to inject a second medicament from the second prefilled syringe through the second needle; a housing receiving the first housing body and the second housing body; and an outer cap receiving the first cap and the second cap, wherein the outer cap is configured to remove the first cap from the first housing body and the second cap from the second housing body.

2. The system of claim 1, wherein the first autoinjector and the second autoinjector are each configured to expel a fixed dose.

3. The system of claim 1 or claim 2, wherein the first autoinjector and the second autoinjector are identical.

4. The system of at least one of claims 1-3, wherein the housing includes an outer wall forming a sleeve around the first autoinjector and the second autoinjector.

5. The system of claim 4. wherein the outer wall defines one or more lumens that receives the first autoinjector and the second autoinjector.

6. The system of claim 5, wherein the outer wall defines a lumen that receives the first autoinjector and the second autoinjector.

7. The system of claim 4 or 5, wherein the lumen defines a first enlarged region receiving the first autoinjector, a second enlarged region receiving the second autoinjector, and a narrow region separating the first and second enlarged regions.

8. The system of at least one of claim 4-6, wherein the outer wall includes a first lobe around the first autoinjector and a second lobe around the second autoinjector, wherein the first lobe and the second lobe are separated by at least one longitudinal recess.

9. The system of at least one of claims 1-8, further comprising a third autoinjector having a third housing body enclosing a third prefilled syringe, a third cap releasably attached to the third housing body, and a third injection spring configured to inject a third medicament from the third prefilled syringe, wherein the housing receives the third autoinjector.

10. The system of claim 9, wherein the first autoinjector, the second autoinjector, and the third autoinjector are in a tnangular arrangement inside of the housing.

11. The system of at least one of claims 1-10, wherein the housing has an open proximal end, and the first housing body and the second housing body extend proximally from the housing.

12. The system of at least one of claims 1-11, wherein the first autoinjector and / or the second autoinjector has at least one label, and the at least one label is visible from outside of the housing.

13. The system of at least one of claims 1-12, wherein the first autoinjector includes: a first cover sleeve extending from the first housing body and a first cover sleeve spring configured to bias the first cover sleeve over the first needle, wherein pressing the first cover sleeve is configured to release the first injection spring, wherein the second autoinjector includes: a second cover sleeve extending from the second housing body and a second cover sleeve spring configured to bias the second cover sleeve over the second needle, wherein pressing the second cover sleeve is configured to release the second injection spring, and wherein removing the outer cap exposes at least a distal portion of the first cover sleeve and at least a distal portion of the second cover sleeve.

14. The system of at least one of claims 1-13, wherein the first cover sleeve and the second cover sleeve extend distally from the housing.

15. The system of at least one of claims 1-14, wherein the outer cap is configured to remove the first cap from the first autoinjector prior to removing the second cap from the second autoinjector.

16. The system of claim 15, wherein the outer cap includes: a first ledge configured to engage the first cap to pull the first cap from the first autoinjector, and a second ledge configured to engage the second cap to pull the second cap from the second autoinjector, wherein the second ledge is longitudinally offset of the first ledge.

17. The system of at least one of claims 16, wherein the outer cap includes: a first groove proximal of the first ledge and configured to receive a first radial projection of the first cap, and a second groove proximal of the second ledge and configured to receive a second radial projection of the second cap, wherein the second groove has a longitudinal length longer than a longitudinal length of the first groove.

18. The system of at least one of claims 1-17, wherein the housing has a closed proximal end configured to transfer a distal force applied to the housing to the first and second autoinjectors so as to simultaneously initiate an injection from the first and second autoinjectors.

19. The system of at least one of claims 1-18, wherein the first prefilled syringe contains a first medicament and the second prefilled syringe contains a second medicament that is the same as the first medicament.

20. The system of at least one of claims 1-19, wherein the first prefilled syringe contains a first medicament and the second prefilled syringe contains a second medicament that is different than the first medicament.

21. A system for packaging a first injector and a second injector, the system comprising: a housing configured to receive the first autoinjector and the second autoinjector; and an outer cap configured to receive a first cap of the first autoinjector and a second cap of the second autoinjector, the outer cap including:a first ledge configured to engage the first cap to pull the first cap from a first housing body of the first injector; and a second ledge configured to engage the second cap to pull the second cap from a second housing body the second injector, wherein the second ledge is longitudinally offset of the first ledge.

22. The system of claim 21, wherein the outer cap extends over a distal portion of the housing.

23. The system of claim 21 or claim 22, wherein the first ledge is configured to extend at least partially around the first cap. and the second ledge is configured to extend at least partially around the second cap.

24. The system of at least one of claims 21-23, wherein the outer cap includes: a first groove proximal of the first ledge and configured to receive a first radial projection of the first cap; and a second groove proximal of the second ledge and configured to receive a second radial projection of the second cap, wherein the second groove has a longitudinal length longer than a longitudinal length of the first groove.

25. A system comprising: a first autoinjector having a first housing body coupled to a first cap; a second autoinjector having a second housing body coupled to a second cap; a housing receiving the first housing body and second housing body; and an outer cap receiving the first cap and the second cap, the outer cap including: a first ledge configured to engage the first cap to pull the first cap from the first housing body; and a second ledge configured to engage the second cap to pull the second cap from the second housing body, wherein the second ledge is longitudinally offset of the first ledge.

26. The system of claim 25, wherein the first autoinjector includes a first prefilled syringe containing a first medicament, and the second autoinjector includes a first prefilled syringe containing a first medicament.

27. A method of removing a first cap of a first autoinjector and a second cap of a second autoinjector with an outer cap. the method comprising: moving the outer cap a first distance to pull the first cap from a first housing body of the first autoinjector without pulling the second cap; and subsequently moving the outer cap a second distance to pull the second cap from a second housing body of the second autoinjector.

28. The method of claim 27, wherein the first cap has a first radial projection received in a first groove of the outer cap, and moving the outer cap the first distance includes pulling the first radial projection with a first ledge on a distal end of the first groove.

29. The method of claim 27, wherein the second cap has a second radial projection received in a second groove of the outer cap, and moving the outer cap the first distance includes sliding the second radial projection through the second groove without pulling the second cap.

30. The method of claim 27, wherein the first autoinjector and the second autoinjector are received in a housing.31 . The method of claim 30, wherein a distal portion of the housing is received in the outer cap, and moving the outer cap the first distance pulls the outer cap distally from the housing.

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