Discrete Choice Experiment: Treatment Preferences of Atopic Dermatitis Patients

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Patients with atopic dermatitis place value on both clinical benefits and diminished risks, according to late-breaking data presented at the Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting in Chicago, though the extent to which such individuals accepted different administration modes and risks showed variations.¹

These findings resulted from a study led by Matthew Quaife of Patient Centered Research in Evidera, London. The research was designed to allow new insights into eczema patients’ value on various types of treatment attributes, highlighting the necessity to improve understanding about how patients determine their therapies and to encourage shared decision-making.

Patient preferences had been a focus of prior research in last year's RAD 2024 conference, with these new findings contributing to a greater understanding of these topics.²

The condition of atopic dermatitis is known to mostly impact the skin, though it is also known for its being a systemic inflammatory disease linked to significant patient burden and heterogenous effects on such patients’ quality of life. Given the outgrowth in recent years of both biologic and non-biologic treatments in this space, Quiafe et al. determined that it would be beneficial to study the decisions made between therapy administration, benefits, and risks.

Design

An online discrete choice experiment (DCE) was carried out by the research team using 400 adult patients with eczema from the US, with the survey being done from November 2023 - January 2024. The attributes and levels used within the DCE were determined by the team based upon a targeted review of treatment evidence literature.

Sociodemographic information, clinical questionnaires, life quality assessments, and the Atopic Dermatitis Control Tool (ADCT) were all collected by the investigators. Participants also chose, during each of their assigned tasks, between 2 hypothetical treatment profiles or chose instead to carry on with their existing treatment plan.

The therapies assessed by the team were described by participants based upon their leading to itch reduction achievement, the existence of a US Food and Drug Administration (FDA) boxed warning, the chance of clearer skin achievement, time to the drug’s onset of action, risk of reaction at injection sites, risk of side effect experiences resulting in treatment discontinuation, and type and frequency of the drug’s administration.

Information related to subject preferences were assessed through the use of an effects-coded mixed-multinomial-logit model (MXL). The investigators also utilized a latent class logit model with the goal of identifying whether or not varying preference patterns could coexist within the sample.

The research team also looked at participants’ relative attribute importance (RAI) scores, as well as willingness of subjects to trade-off between different types of attributes.

Findings

Topical therapies were reported by the investigators to be currently utilized by 78% of those they surveyed, with 42% using oral options, and 13% using injectables. Subjects’ mean ages were noted as 44.9 years, with 78% reported as White, 72% reported as female, and 10% Hispanic/Latino.

The research team also found that 34% of the participants had reported experiencing (currently or previously) the use of a treatment that had an FDA boxed warning. Mean ADCT scores of 6.95 were noted among the participants, with ≥7 suggesting poorly controlled disease.

The investigators stratified the subjects into 3 distinct preference cohorts: Those labeled ‘Boxed Warning Avoiders’ (BWA; 11.5%), those labled ‘Efficacy Focused’ (EF; 65.4%), and those labeled ‘Injectable Avoiders’ (IA; 23.1%). Among all 3 cohorts, the drug’s ability to lead to greater benefits (achieving clearer skin RAI: 28%; reducing itch: 22%) were found by the team to have the highest impact on subjects’ preferences compared to avoiding risks (discontinuation: 9%; FDA warning: 9%; injection site reaction: 9%).

Despite these findings, the investigators added that the relative value participants placed on drug attributes had been varied, with Injectable Avoiders placing great importance on frequency of administration as well as mode. Specifically, they tended to prefer oral or topical options compared to injectables, regardless of frequency, and prioritized injection site reaction avoidance.

Boxed Warning Avoiders were heavily against use of drugs with said boxed warnings and valued reduction of pruritus and avoidance of discontinuation greatly.

On the other hand, those who were Efficacy Focused prioritized itch reduction and skin clearance nearly twice as much as other groups. They did not give as much attention to the differentiation of the elements of treatments such as type and administration frequency.

References

1. ^{Quaife M, Mulnick S, Chovatiya R, et al. Patient preferences for atopic dermatitis treatment profiles: results from a discrete choice experiment. Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting June 8 – 10, 2024. Chicago, IL.}
2. ^{Kunzmann K. What Do Atopic Dermatitis Patients Want From Their Therapy? HCPLive. April 30 2023. https://www.hcplive.com/view/what-do-atopic-dermatitis-patients-want-therapy. Date accessed: June 12, 2024.}