Patients With AD Prioritize Itch Control in Treatment Preferences

Patients with atopic dermatitis (AD) prefer treatments that maximize itch control while minimizing adverse event (AE) risks, according to a study published in the Journal of Dermatological Treatment.¹

The researchers explained that there are various treatment solutions for moderate to severe AD, including systemic therapies, biologics, and topical emollients.² Also, they noted that Janus kinase (JAK) inhibitors and monoclonal antibodies are new options that have recently become available.¹ Despite this treatment variety, existing US studies on patient preferences for AD treatments are limited in scope.

Because of the differences in health care and cultural environments that may affect the preferences of US patients with AD, the researchers noted that a comprehensive discrete choice experiment (DCE) study is needed; DCEs quantify treatment preferences and tradeoffs patients are willing to make between the risks and benefits of various treatment options.

Consequently, the researchers conducted a DCE study to better understand the treatment preferences of US patients with moderate to severe AD.

Female patient scratching atopic dermatitis (AD) | Image Credit: KMPZZZ - stock.adobe.com

The researchers recruited their study population through email invitations and conducted data collection for the online DCE survey in June 2023. Eligible participants were US patients aged 18 years or older who had been diagnosed with AD for at least 1 year and had experienced inadequate topical treatment responses.

The researchers conducted their study in 2 phases. Phase I was qualitative and analyzed attributes of importance for treatment decisions, which they identified through a literature review, patient interviews, and clinical opinions. Of the identified attributes, those analyzed in Phase II included the probability of achieving meaningful itch control, blood test frequency, and sustained improvement in skin appearance; they also analyzed the frequency and mode of administration, along with risks of cancer, heart problems, or respiratory infections.

Based on these attributes, the researchers generated 40 choice tasks using software for DCEs. To limit the response burden, they divided the choice tasks into 4 blocks with 10 tasks. Each participant was randomly assigned to one block during the survey; they also were presented with 2 additional choice tasks to assess the internal validity of the responses.

Therefore, the researchers presented the participants with 12 choice tasks, each containing 2 hypothetical AD treatment profiles with various attribute level combinations. For each choice task, participants had to choose the treatment they preferred between the 2 options. Based on the survey results, the researchers used preference weights estimated from conditional logistic regression models to calculate the patient's willingness to trade off treatments and the attributes’ relative importance (RI).

Overall, 300 patients completed the survey, 70% of whom were female. Of these patients, 50% experienced severe symptoms at some point after their AD diagnosis, and around half (49.7%) received their first AD treatment at least 5 years ago. Additionally, most patients (87.8%) were affected by AD on visible body regions, like their face, neck, hands, or feet. At the time of survey completion, most (80.0%) patients were treated with topical treatments, while 31.0% received oral therapies, and 14.7% received injectable therapies; of the study population, 52.0% had systemic therapy experience.

In terms of treatment attributes, patients ranked itch control (RI, 38%) as the most important, followed by cancer risk (RI, 23%), respiratory infection risk (RI, 18%), and the risk of heart problems (RI, 11%). Conversely, the researchers found sustained skin appearance improvement (RI, 5%), blood test frequency (RI, 3%), and frequency and mode of administration (RI, 2%) to be the least important attributes.

The researchers acknowledged the study's limitations, one being that it only included respondents who agreed to participate. Therefore, the study population may differ from the broader US population with moderate to severe AD. Also, the study required patients to self-report various characteristics, meaning some, like AD diagnosis and severity, could not be confirmed. Despite these limitations, the researchers made treatment recommendations based on their findings.

“Physicians and patients should consider the risk of AEs—especially serious AEs, such as malignancy and heart problems—associated with certain treatments when making treatment decisions, by carefully considering the implications on patients’ adherence to treatment and related quality of life, as well as the impacts on the health care system more generally,” the authors wrote.

References

1. Feldman SR, Guerin A, Gauthier-Loiselle M, et al. Patient preferences for treatment attributes in moderate-to-severe atopic dermatitis: a discrete choice experiment. J Dermatolog Treat. 2024;35(1):2345739. doi:10.1080/09546634.2024.2345739

2. Howe W, Paller AS, Butala S, et al. Treatment of atopic dermatitis (eczema). UpToDate Waltham. 2022;MA2021.