What Do Atopic Dermatitis Patients Want From Their Therapy?

Steven R. Feldman, MD, PhD

Credit: Twitter

Patient preference for treatment of their atopic dermatitis hinge mostly on efficacy attributes, risk of adverse events and the frequency by which they receive said treatment, according to new findings from a qualitative interview study.¹

In new data presented at the Revolutionizing Atopic Dermatitis (RAD) 2023 Spring Conference in Washington, DC, this weekend, a multinational team of investigators uncovered unique, individual perspective on treating atopic dermatitis and their preferences in doing so from a cohort of adult patients with moderate to severe disease.

The findings, financially sponsored by LEO Pharma, are hoped to eventually provide a guideline to a subsequent discrete choice experiment (DCE) that would quantify the relative significance of the patients’ varied treatment attributes.

Led by Steven R. Feldman, MD, PhD, professor of dermatology at Wake Forest University School of Medicine, investigators conducted the qualitative, patient interview-based assessment to evaluate the treatment attributes critical to adult patients with moderate to severe atopic dermatitis. Feldman and colleagues highlighted the increasing diversity of atopic dermatitis treatment options, which in recent years has expanded to include phototherapy, corticosteroids, Janus kinase (JAK) inhibitors and biologic therapies, among others.

“These treatments offer varied levels of efficacy, safety, response times, and modes of administration,” they wrote. “Yet, patient preferences for these treatment options and attributes influencing treatment choice are not well characterized.”

The team conducted semi-structured 60-minute phone interviews with a panel of geographically and demographically diverse US patients with atopic dermatitis. Eligible patients had been diagnosed for ≥1 year, had prior inadequate response to topical therapy, and either had moderate to severe disease or experience with systemic therapies.

Participants were asked to rate the importance of 17 treatment attributes—stratified by efficacy, adverse events (AEs), and logistics—on a 1-5 scale, with 5 indicating highest importance, on the role of each in treatment decision-making.

The 4 components of efficacy attributes pertained to how long the treatment lasts; improvement in skin appearance; reduction of itchiness; and speed of onset. The 9 components of AE attributes pertained to risk of side effects associated with treatments including cancer, cardiovascular events, and nausea. The 4 components of logistics attributes pertained to the frequency of administration; monitoring visits; mode of administration; and treatment cost.

Among the 10 interview participants, 7 were female; 8 were ≥35 years old; 7 were White; and 7 each had been diagnosed with atopic dermatitis ≥5 years and had experience with systemic therapy.

The following treatment attributes were ranked the highest in priority by mean participant score:

1. How long treatment improvement lasts (4.6)
2. Improvement in skin appearance (4.4)
3. Risk of respiratory infections (4.3)
4. Reduction in itchiness (4.3)
5. Frequency of administration (4.2)

The following treatment attributes were ranked the lowest in priority by mean participant score:

• Risk of headache (2.9)
• Risk of nausea (3.1)
• Treatment cost (3.2)
• Mode of administration (3.4)
• Monitoring visits (3.6)

Investigators highlighted notable comments from interview participants, including a patient who said, "I would not risk any of these serious side effects for a new treatment even if it works.” Another commented that they are “constantly reminded…that I have something wrong” due to their daily oral treatment administration. Another expressed willingness to take a drug that may have a delayed onset but higher long-term efficacy.

The investigators concluded their findings show adult patient preference for atopic dermatitis drugs that address skin clearance, lessened risk of severe AEs, and provide less frequent administrations.

“Results shed light on patient experience and preferences related to treatments for moderate-to-severe atopic dermatitis and elucidate the treatment attributes that most impact adult patient preferences,” they wrote. “These results will guide the design of a subsequent quantitative DCE quantify the relative importance of the different treatment attributes relevant to moderate- to-severe atopic dermatitis.”

References

1. ^{Feldman S, Guerin A, Gauthier-Loiselle M, Claxton A, et al. Understanding Patient Experience and Factors Influencing Patient Preference in the Treatment of Moderate-to-Severe Atopic Dermatitis Through In-Depth Qualitative Patient Interviews. Paper presented at: Revolutionizing Atopic Dermatitis 2023 Spring Conference; April 29 – May 1, 2023; Washington, DC. Accessed April 30, 2023.}