Psoriasis Patients Make Personalized Treatment Tradeoffs

August 16, 2016

The choice of treatment for psoriasis is highly personal. Some psoriasis patients are willing to trade decreased safety for increased effectiveness or increased convenience.

The trade-offs that psoriasis patients make in treatment decisions are highly personalized based on the interpretation and relative value placed on effectiveness, safety, and convenience, according to the results of a recent focus group study.

​Some psoriasis patients are willing to opt to trade decreased safety (adverse effects) for increased effectiveness (better therapeutic outcome) or increased convenience (compatibility with personal and professional life). Other patients are willing to trade decreased effectiveness (time to achieve moderate skin improvement) to increase safety (minimize the risk), stated the researchers, led by Jaehwan Kim, M.D., Ph.D., Instructor in Clinical Investigation at The Rockefeller University Laboratory for Investigative Dermatology.

“It has been reported that psoriasis patients are faced with difficult treatment decisions, and a large proportion of psoriasis patients want to participate in decision-making. This study elucidates that treatment effectiveness, safety and convenience are key decision factors with many interpretations and trade-offs,” Dr. Kim said in an interview with Rheumatology Network.

Dr. Kim and colleagues conducted eight focus groups between November 2013 and January 2015, enrolling 41 psoriasis patients, mean age 51.2 years with a mean duration of psoriasis of 16.2 years. The patients’ mean Dermatology Life Quality Index score was 8.2, indicating that psoriasis had a moderate effect on their lives, he said. The researchers reported their results in the June 2016 JAMA Dermatology.  [[{"type":"media","view_mode":"media_crop","fid":"51097","attributes":{"alt":"©Artemidapsy/Shutterstock","class":"media-image media-image-right","id":"media_crop_6516331274379","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6284","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©Artemidapsy/Shutterstock","typeof":"foaf:Image"}}]]

They found that trade-offs in treatment decision-making emerged as a strong theme across all focus groups. “Personal trade-offs are made when deciding between viable treatment options, often involving an uncertain balancing of key decision factors. In general, patients place safety and effectiveness over convenience, and some patients may favor effectiveness over possible safety issues,” Dr. Kim said “For example, patients weighed the benefits of having clear skin against the risks of organ damage from prolonged systemic treatment, or of rebounding symptom severity with treatment cessation.”

The researchers noted that the patients were interested in using patient decision aids, in online format and in-person with a clinician. “If the patient decision aids interact with patients to elicit individual perceptions of the trade targets, the patient decision aids can incorporate patient preferences and offer ranked lists of treatment options for personalized treatment trade-offs,” he said.

As many treatment options exist for the treatment of rheumatic diseases, more patients want to be involved in discussing treatment options with their health care providers. “To facilitate the shared decision-making process using patient decision aids, patient treatment preferences should be elaborately integrated into the design of the patient decision aids,” Dr. Kim said.

The effects of ixekizumab on work productivity

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The effects of ixekizumab on work productivity

Psoriasis can be a misery not only affecting health status, but job security, and may become an economic burden. A new study in the same issue of JAMA Dermatology assessed the effects of ixekizumab on disease status and compared it to work productivity.

The researchers, led by April Armstrong, M.D., associate dean of clinical research at Keck School of Medicine of University of Southern California, analyzed data from three phase 3, randomized, multicenter, double-blind, placebo-controlled, parallel-group trials. In the UNCOVER-1 trial, patients were randomized to subcutaneous placebo or 80 mg ixekizumab every 2 weeks (Q2W) or every 4 weeks (Q4W) for 12 weeks; the UNCOVER-2 and UNCOVER-3 trials also included an etanercept arm (50 mg twice weekly).

Ixekizumab is an anti-interleukin 17A IgG4 monoclonal antibody with high binding affinity to the soluble cytokine interleukin 17A, which is key in the development and persistence of psoriasis.

In the analysis of 3,866 randomized patients, the effect of ixekizumab on work productivity was evaluated at 12 weeks by the change from baseline as measured by Work Productivity and Activity Impairment-Psoriasis (WPAI-PSO) scores, which is a validated, self-reported questionnaire used to measure impairment of work activities due to general health or a specific condition.

“During the first 12 weeks of treatment, patients with psoriasis treated with ixekizumab 80 mg Q2W and ixekizumab 80 mg QW4 experienced an overall increase in work productivity and improvement in their abilities to perform daily activities relative to placebo-treated patients,” they state.

In UNCOVER-1, improvements in work productivity were also sustained up to 60 weeks in those who demonstrated initial clinical response to ixekizumab at 12 weeks. Also, in UNCOVER-1 and UNCOVER-2, significant improvements from baseline were sustained through 60 weeks among patients treated with ixekizumab for presenteeism, work productivity loss and activity impairment scores.

The ixekizumab 80 mg twice-weekly group was significantly better in reducing activity impairment as compared to etanercept and “in UNCOVER-2, ixekizumab-treated patients also experienced improved presenteeism and work productivity loss scores relative to etanercept-treated patients,” they state.

The researchers suggest that treatment with ixekizumab, if approved, would sustainably reduce the negative effect of psoriasis on patients’ work productivity and engagement in activities outside work.

 

References:

Schaarschmidt ML, Schmieder A. et al. “Patient preferences for psoriasis treatments:  process characteristics can outweigh outcome attributes,” Archives of Dermatology. 2011;147(11):1285-1294. doi:10.1001/archdermatol.2011.309.

 

Elizabeth M. Seston, PhD; Darren M. Ashcroft, PhD; Christopher E. M. Griffiths, MD. "Balancing the Benefits and Risks of Drug Treatment A Stated-Preference, Discrete Choice Experiment With Patients With Psoriasis," Archives of Dermatology. Arch Dermatol. 2007;143(9):1175-1179. doi:10.1001/archderm.143.9.1175

 

Jaehwan Kim, MD, PhD; Dong Joo Kim, MD; et al. "Patients With Psoriasis and Personalized Trade-offs in Treatment Decisions-Lessons Learned From Focus Groups," JAMA Dermatology. 2016;152(6):720-722. doi:10.1001/jamadermatol.2016.0501.

 

Elizabeth A. Brezinski, MD; Jaskaran S. Dhillon; April W. Armstrong, MD. “Economic Burden of Psoriasis in the United States, A Systematic Review,” JAMA Dermatology. 2015;151(6):651-658. doi:10.1001/jamadermatol.2014.3593.

 

Armstrong AW, Lynde CW, et al. “Effect of Ixekizumab Treatment on Work Productivity for Patients With Moderate-to-Severe Plaque Psoriasis: Analysis of Results From 3 Randomized Phase 3 Clinical Trials,” JAMA Dermatology. June 2016. 152(6):661-669. doi:10.1001/jamadermatol.2016.0269.

 

Schaarschmidt ML, Schmieder A. et al. “Patient preferences for psoriasis treatments:  process characteristics can outweigh outcome attributes,” Archives of Dermatology. 2011;147(11):1285-1294. doi:10.1001/archdermatol.2011.309.

 

Elizabeth M. Seston, PhD; Darren M. Ashcroft, PhD; Christopher E. M. Griffiths, MD. "Balancing the Benefits and Risks of Drug Treatment A Stated-Preference, Discrete Choice Experiment With Patients With Psoriasis," Archives of Dermatology. Arch Dermatol. 2007;143(9):1175-1179. doi:10.1001/archderm.143.9.1175

 

Jaehwan Kim, MD, PhD; Dong Joo Kim, MD; et al. "Patients With Psoriasis and Personalized Trade-offs in Treatment Decisions-Lessons Learned From Focus Groups," JAMA Dermatology. 2016;152(6):720-722. doi:10.1001/jamadermatol.2016.0501.

 

Elizabeth A. Brezinski, MD; Jaskaran S. Dhillon; April W. Armstrong, MD. “Economic Burden of Psoriasis in the United States, A Systematic Review,” JAMA Dermatology. 2015;151(6):651-658. doi:10.1001/jamadermatol.2014.3593.

 

Armstrong AW, Lynde CW, et al. “Effect of Ixekizumab Treatment on Work Productivity for Patients With Moderate-to-Severe Plaque Psoriasis: Analysis of Results From 3 Randomized Phase 3 Clinical Trials,” JAMA Dermatology. June 2016. 152(6):661-669. doi:10.1001/jamadermatol.2016.0269.