Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy.
Patient-Centered Research, Evidera, London, UK.
Rheumatology (Oxford). 2022 Oct 6;61(10):4035-4046. doi: 10.1093/rheumatology/keac126.
Treatments for SSc-associated interstitial lung disease (SSc-ILD) differ in attributes, i.e. mode of administration, adverse events (AEs) and efficacy. As physicians and patients may perceive treatments differently, shared decision-making can be essential for optimal treatment provision. We therefore aimed to quantify patient preferences for different treatment attributes.
Seven SSc-ILD attributes were identified from mixed-methods research and clinician input: mode of administration, shortness of breath, skin tightness, cough, tiredness, risk of gastrointestinal AEs (GI-AEs) and risk of serious and non-serious infections. Patients with SSc-ILD completed an online discrete choice experiment (DCE) in which they were asked to repeatedly choose between two alternatives characterized by varying severity levels of the included attributes. The data were analysed using a multinomial logit model; relative attribute importance and maximum acceptable risk measures were calculated.
Overall, 231 patients with SSc-ILD completed the DCE. Patients preferred twice-daily oral treatments and 6-12 monthly infusions. Patients' choices were mostly influenced by the risk of GI-AEs or infections. Improvement was more important in respiratory symptoms than in skin tightness. Concerning trade-offs, patients accepted different levels of increase in GI-AE risk: +21% if it reduced the infusions' frequency; +15% if changing to an oral treatment; up to +37% if it improved breathlessness; and up to +36% if it reduced the risk of infections.
This is the first study to quantitatively elicit patients' preferences for treatment attributes in SSc-ILD. Patients showed willingness to make trade-offs, providing a firm basis for shared decision-making in clinical practice.
硬皮病相关间质性肺病（SSc-ILD）的治疗方法在给药方式、不良反应（AE）和疗效等方面存在差异。由于医生和患者对治疗方法的看法可能不同，因此共同决策对于提供最佳治疗方案至关重要。因此，我们旨在量化患者对不同治疗属性的偏好。
从混合方法研究和临床医生的意见中确定了 7 个 SSc-ILD 属性：给药方式、呼吸急促、皮肤紧绷、咳嗽、疲劳、胃肠道 AE（GI-AE）风险和严重及非严重感染风险。ILD 的 SSc 患者完成了在线离散选择实验（DCE），他们被要求在两种替代方案之间反复选择，这两种替代方案的特征是包含的属性具有不同的严重程度水平。使用多项逻辑回归模型对数据进行分析；计算相对属性重要性和最大可接受风险措施。
共有 231 名 SSc-ILD 患者完成了 DCE。患者更喜欢每日两次口服治疗和每 6-12 个月输注一次。患者的选择主要受 GI-AE 或感染风险的影响。呼吸症状的改善比皮肤紧绷更为重要。关于权衡取舍，患者接受了不同程度的 GI-AE 风险增加：如果它降低了输注频率，则增加 21%；如果改为口服治疗，则增加 15%；如果它改善了呼吸困难，则增加高达 37%；如果它降低了感染风险，则增加高达 36%。
这是第一项定量研究 SSc-ILD 患者对治疗属性偏好的研究。患者表现出愿意做出权衡取舍，为临床实践中的共同决策提供了坚实的基础。
