Evaluation of Psoriasis Patients’ Attitude to Risk: Benefit And Therapeutic Tradeoffs In Their Choice of Treatments

Abstract

A425Objectives: Treatment options continue to emerge for managing psoriasis, with different risk:benefit profiles and routes of administration. This study was designed to elicit UK patients' relative strength of preference regarding treatment effectiveness, risks of side effects, and mode/frequency of administration. MethOds: A stated preference survey (using a discrete choice experiment [DCE]) was designed to present participants with hypothetical treatment choices. Treatments were described in terms of reducing the body surface area (BSA) affected by psoriasis, mode of administration, increase in risk of diarrhea or nausea in the short-term, and 10-year risk of melanoma, tuberculosis, or serious infection (e.g., pneumonia). Standard DCE Methodswith an orthogonal design were used; the survey was pilot-tested in 6 participants. Results: Psoriasis patients (n= 292; mean age= 48.5 years; mean BSA= 9.3%; mean Dermatology Life Quality Index= 10.5; 25.7% with prior biologic experience and 34.9% with psoriatic arthritis) were recruited in the UK. Participants strongly preferred to avoid increasing their risk of melanoma (odds ratio [OR]= 0.44/5% increased 10-year risk), tuberculosis, and serious infections (OR= 0.73/5% increased 10-year risk for both) and preferred twice-daily tablets to weekly injections (OR= 0.74) or injections every 2 weeks (OR= 0.86). Participants preferred to avoid treatments with a risk of diarrhea or nausea in the first few weeks after initiation (OR= 0.87/5% increase) and preferred treatments that effectively resolve plaque lesions (OR= 0.93 for each hand palm area still affected). All ORs were statistically significant. Biologic-naïve participants were more likely to prefer oral tablets to injections and were less risk-tolerant for serious adverse events. cOnclusiOns: All attributes of treatment considered were found to be significant predictors of choice. Patients showed strong preferences for avoiding treatments with risk of serious toxicities and avoiding injectable therapy, and a lower preference for treatments with greater efficacy. These preferences were consistently stronger in biologic-naïve patients.