Survey of patient preferences for the treatment of atopic dermatitis

European adult patients with atopic dermatitis most valued therapies that were fast-acting, orally administered, and could be interrupted, even at the cost of reduced efficacy.

Patient preferences for treating adults with atopic dermatitis (AD) highlight the value of oral administration, less frequent monitoring, and rapid onset, even at the cost of reduced efficacy. The results of the study have been published in BMJ open.

Current AD management includes emollients and moisturizers, topical corticosteroids, and calcineurin inhibitors, with systemic immunosuppressants and biologics used for moderate to severe disease. For other chronic diseases, the researchers note that some patients prefer oral therapy to parenteral therapy due to administration barriers, which can lead to decreased compliance.

“Because non-health benefits cannot be captured in traditional cost-effectiveness analysis, understanding the extent to which they are valued by patients can help guide health technology assessment discussions and inform the point-of-care shared decision-making,” they said.

“Preferences for different treatment attributes, such as their benefits, risks, mode of delivery, and convenience characteristics, can be elicited from patients using discrete-choice experiments (DCEs).”

Study authors conducted an online DCE survey to determine the preferences of AD patients living in the UK, France and Spain for key attributes of therapy efficacy, safety and convenience targeted against AD, as well as to examine the trade-offs they are willing to make among themselves.

A total of 404 AD patients (mean [SD] age, 44.1 [12.0] years; 65% women; 64% moderate/severe eczema) were asked between October and December 2019 on a series of choice tasks in which they selected between hypothetical treatment options described by a set of attributes at different levels:

  • chance of achieving clear or almost clear skin at week 16
  • chance of achieving a significant reduction in itching at week 16
  • risk of eye inflammation
  • risk of serious infections
  • administration
  • flare management
  • long-term disease management
  • surveillance
  • speed of onset

“Attribute preferences were analyzed using a multinomial logit model. Willingness to compromise was expressed as the maximum acceptable decrease (MAD) in the likelihood of achieving clear/near-clear skin at week 16,” the researchers explained.

Among the study cohort, a majority of patients (68%) had no prior experience of using self-injectable treatments for AD or any other disease. Topical corticosteroids (66%) were the most frequently used drug class at the time of the survey, followed by systemic immunosuppressive therapies (27%) and biologics (18%).

In terms of patient preferences, participants most valued the increased odds of achieving a significant reduction in itch at week 16 of 20% to 50%, followed by reduced risk of serious infections from 6% to 0% and eye inflammation from 20% to 0%.

In addition, participants were willing to accept a decrease in the possibility of obtaining clear/almost clear skin to have a treatment that can be interrupted (MAD = 24.1%), requires occasional check-ups (MAD = 16.1 %) or no control (MAD = 20.9%) compared to frequent controls, is given as an oral pill once daily or twice daily compared to subcutaneous injection every 2 weeks (MAD = 16.6%), has a 2 day duration over 2 week onset (MAD = 11.3%) and can be used for flare management (MAD = 5.8%).

“Understanding patient preferences for AD therapies, including novel targeted therapies, can facilitate shared decision-making between clinicians and patients and support health technology assessments,” the authors concluded. ‘study.

Reference

Thomas C, Raibouaa A, Wollenberg A, et al. Patient preferences for drugs for atopic dermatitis in the UK, France and Spain: a discrete choice experiment. BMJ open. 2022 Aug 2;12(8):e058799. doi:10.1136/bmjopen-2021-058799

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