Acta Demato-Venereologica 98-2CompleteContent | Page 12

200 CLINICAL REPORT Patients’ and Physicians’ Preferences for Systemic Psoriasis Treatments: A Nationwide Comparative Discrete Choice Experiment (PsoCompare) Marthe-Lisa SCHAARSCHMIDT 1 , Raphael HERR 2 , Mandy GUTKNECHT 3 , Katharina WROBLEWSKA 4 , Sascha GERDES 5 , Michael STICHERLING 6 , Matthias AUGUSTIN 3 and Wiebke K. PEITSCH 1,7 Department of Dermatology, University Medical Center Mannheim, 2 Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, 3 Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, 4 Dermatological Practice Wroblewska, Spaichingen, 5 Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Kiel, 6 Department of Dermatology, University Hospital of Erlangen, Erlangen, and 7 Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany 1 Systemic antipsoriatic treatment options are increa- sing rapidly. The aim of this nationwide discrete choi- ce experiment was to compare patients’ (n  = 222) and physicians’ (n  = 78) preferences for outcome and pro- cess attributes of systemic antipsoriatics using Rela- tive Importance Scores (RIS). Both groups considered Psoriasis Area and Severity Index 90 (PASI 90) to be most important (RIS 21.4 and 20.8, respectively). Mo- reover, patients were highly concerned about mild and severe adverse events (RIS = 18.2 and 14.2), physici- ans about severe adverse events (RIS = 14.9) and cost (RIS = 13.8). Compared to physicians, patients worried more about mild adverse events and treatment loca- tion, but less about cost and frequency of laboratory tests. Physicians’ preferences were influenced by work experience and percentage of biological prescr iptions, patients’ preferences by age, disease duration and se- verity. Older and less severely affected patients recrui- ted via a patient organization focused more on safety, but less on efficacy and time until response than did patients from study centres. In conclusion, these diffe- rences in trade-offs should be integrated into a shared decision-making. Key words: biologicals; conjoint analysis; discrete choice expe- riment; preferences; psoriasis; systemic treatment. Accepted Nov 2, 2017; Epub ahead of print Nov 7, 2017 Acta Derm Venereol 2018; 98: 200–205. Corr: Wiebke K. Ludwig-Peitsch, Department of Dermatology and Phle- bology, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, DE- 10249 Berlin, Germany. E-mail: [email protected] P soriasis has a prevalence of 2–3% in Northern countries. Approximately 20% of patients have moderate-to-severe psoriasis and require systemic treat- ment. Traditional medications approved for this indica- tion in Germany are acitretin, cyclosporine, fumaric acid esters and methotrexate (1). Biologicals and apremilast have substantially expanded the treatment repertoire in the last decade. Biologicals are associated with a more favourable risk-benefit profile, but also with higher medi- cation costs than are traditional drugs (2–9). Therefore, biologicals are mostly prescribed second- or third-line doi: 10.2340/00015555-2834 Acta Derm Venereol 2018; 98: 200–205 in Germany, although interleukin 17 antagonists and the tumour necrosis factor (TNF) inhibitor adalimumab have first-line approval. Several novel systemic drugs are expected to become available soon (10–12). Systemic antipsoriatics differ considerably from each other in terms of efficacy, safety, adverse events (AE), ad- ministration process, costs and monitoring requirements. Due to the rapidly increasing number of options, several medications may be suitable for an individual patient. The choice of a specific drug depends on the physician’s assessment, experience and prescription preferences. However, the medication should also match the patient’s preferences, which must be included to provide patient- centred care (13, 14). Physicians can counsel patients more appropriately if they understand their perspective. They should be aware that their own perception and the patients’ view may differ (14, 15) and that mismatch between treatment attributes and patients’ preferences can result in a vicious circle of low satisfaction, non- adherence and suboptimal outcome, problems commonly encountered among patients with psoriasis (16). We recently performed discrete choice experiments (DCE) to evaluate patient preferences for biologicals and showed high preferences for safety and efficacy (17). However, our previous study had a monocentric design, did not address preferences for other systemic treatments and did not consider physicians’ preferences. The aim of the nationwide DCE presented here, the Pso- Compare study, was to compare physicians’ and patients’ preferences for attributes of all systemic medications that were either approved or in advanced development for moderate-to-severe psoriasis. METHODS Participants The study was conducted in Germany from 1 September 2015 to 31 August 2016. Patients were recruited in 2 ways. First, through a call for participation published in the member magazine of the largest German patient organization for psoriasis (Deutscher Pso- riasis Bund e.V.). Secondly, 5 study centres (4 Dermatology De- partments of University Hospitals and 1 dermatological practice) enrolled patients during regular visits. All individuals aged ≥ 18 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.