Investigating Patient Preferences for Atopic Dermatitis Treatment

Patient preferences for treatment in adults with atopic dermatitis (AD) highlight the value of oral administration, less frequent monitoring, and rapid onset—even at the expense of reduced efficacy. Study findings were published in BMJ Open.

Current management of AD consists of emollients and moisturizers, topical corticosteroids, and calcineurin inhibitors, with systemic immunosuppressants and biologics used for moderate to severe disease. For other chronic diseases, researchers note that some patients prefer oral over parenteral treatment due to barriers in administration, which may lead to reduced adherence.

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

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

The study authors conducted an online DCE survey to determine the preferences of patients with AD living in the United Kingdom, France, and Spain for key efficacy, safety, and convenience attributes of targeted AD therapies, as well as examine the trade-offs they are willing to make between them.

A total of 404 patients with AD (mean [SD] age, 44.1 [12.0] years; 65% women; 64% moderate/severe eczema) were surveyed 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 with different levels:

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

“Preferences for attributes were analyzed using a multinomial logit model. Willingness to make trade-offs was expressed as the maximum acceptable decrease (MAD) in the probability of achieving clear/almost clear skin at week 16,” explained researchers.

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

Regarding patient preferences, participants most valued increasing the chance of achieving a meaningful reduction in itch at week 16 from 20% to 50%, followed by reducing the risks of serious infections from 6% to 0% and of eye inflammation from 20% to 0%.

Moreover, participants were willing to accept a decrease in the possibility of achieving clear/almost clear skin to have a treatment that can be paused (MAD = 24.1%), requires occasional check-ups (MAD = 16.1%) or no check-ups (MAD = 20.9%) over frequent check-ups, is administered as a one time per day or 2 times per day oral pill vs a subcutaneous injection every 2 weeks (MAD = 16.6%), has a 2-day over 2-week onset of action (MAD = 11.3%), and can be used for flare management (MAD = 5.8%).

“Understanding patients’ preferences for AD therapies, including new targeted therapies, can aid shared decision-making between clinicians and patients and support health technology assessments,” condluded the study authors.

Reference

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