Hospital St Louis, Paris, France.
Curr Med Res Opin. 2009 Dec;25(12):2835-43. doi: 10.1185/03007990903320576.
Multi-attribute decision-making (MADM) models evaluate competing solutions for complex problems to identify the closest fit to the ideal solution. MADM models may assist dermatologists when selecting between biologics for plaque psoriasis. Here, is described the development of a pilot model to identify the preferred biologic from the dermatologist's perspective.
A group of European dermatologists were surveyed to identify treatment attributes they consider when prescribing a biologic. The relative importance of each was determined by allocation of 100 importance points in the context of seven case vignettes, reflecting the breadth of disease encountered in dermatological practice. Biologic performance was rated anonymously on a scale of 1-10, scores entered into a MADM matrix, and TOPSIS (Technique for Ordered Preference by Similarity to the Ideal Solution) analysis applied to identify the biologic closest to the hypothetical ideal.
Long-term efficacy and safety were the most important attributes considered by dermatologists when selecting a biologic. For one case vignette (chronic stable psoriasis), TOPSIS scores showed that etanercept was closest to the ideal for 63% of respondents, with adalimumab closest to the ideal for 32% of respondents. Differences among the biologics were highly significant (p < 0.0001). For severe unstable psoriasis, infliximab and adalimumab were preferred.
This study was conducted with a group of dermatologists attending a Wyeth-sponsored advisory board meeting.
Based on responses from this expert group, etanercept was the preferred choice for stable chronic plaque psoriasis for the majority, with infliximab preferred for more severe disease. However, there are several limitations to this pilot model, most notably the non-random selection of the expert group. Further development of the model encompassing a random survey of dermatologists and inclusion of other treatment alternatives and the latest clinical data, will add to the clinical utility of the tool.
多属性决策 (MADM) 模型评估复杂问题的竞争解决方案，以确定最接近理想解决方案的方案。MADM 模型可帮助皮肤科医生在斑块状银屑病的生物制剂选择中进行决策。本文描述了一种从皮肤科医生角度出发识别首选生物制剂的试点模型的开发。
对一组欧洲皮肤科医生进行调查，以确定他们在开处方时考虑的治疗属性。通过在七个病例描述中分配 100 个重要点来确定每个属性的相对重要性，这七个病例描述反映了皮肤科实践中遇到的各种疾病。生物制剂的性能在 1-10 的量表上进行匿名评分，评分输入 MADM 矩阵，并应用 TOPSIS（逼近理想解的排序偏好技术）分析来确定最接近理想方案的生物制剂。
长期疗效和安全性是皮肤科医生选择生物制剂时最看重的属性。对于一个病例描述（慢性稳定型银屑病），TOPSIS 评分显示依那西普在 63%的受访者中最接近理想方案，阿达木单抗在 32%的受访者中最接近理想方案。不同生物制剂之间的差异具有高度显著性（p < 0.0001）。对于严重不稳定型银屑病，英夫利昔单抗和阿达木单抗更受青睐。
本研究是在一组参加惠氏赞助的顾问委员会会议的皮肤科医生中进行的。
基于专家组的回答，对于大多数稳定的慢性斑块型银屑病患者，依那西普是首选，对于更严重的疾病，英夫利昔单抗是首选。然而，该试点模型存在一些局限性，最明显的是专家组的非随机选择。进一步开发涵盖皮肤科医生随机调查以及纳入其他治疗选择和最新临床数据的模型，将增加该工具的临床实用性。
