参与被忽视热带病药物研发:一项探索和纳入皮肤利什曼病患者偏好的定性研究,以纳入目标产品特性开发。

Involving patients in drug development for Neglected Tropical Diseases (NTDs): A qualitative study exploring and incorporating preferences of patients with cutaneous leishmaniasis into Target Product Profile development.

机构信息

Centro Internacional de Entrenamiento de Investigaciones Médicas (CIDEIM), Cali, Colombia.

Universidad Icesi, Cali, Colombia.

出版信息

PLoS Negl Trop Dis. 2024 Feb 21;18(2):e0011975. doi: 10.1371/journal.pntd.0011975. eCollection 2024 Feb.

Abstract

BACKGROUND

Target Product Profiles (TPPs) are instrumental to help optimise the design and development of therapeutics, vaccines, and diagnostics - these products, in order to achieve the intended impact, should be aligned with users' preferences and needs. However, patients are rarely involved as key stakeholders in building a TPP.

METHODOLOGY

Thirty-three cutaneous leishmaniasis (CL) patients from Brazil, Colombia, and Austria, infected with New-World Leishmania species, were recruited using a maximum variation approach along geographic, sociodemographic and clinical criteria. Semi-structured interviews were conducted in the respective patient's mother tongue. Transcripts, translated into English, were analysed using a framework approach. We matched disease experiences, preferences, and expectations of CL patients to a TPP developed by DNDi (Drug for Neglected Diseases initiative) for CL treatment.

PRINCIPAL FINDINGS

Patients' preferences regarding treatments ranged from specific efficacy and safety endpoints to direct and significant indirect costs. Respondents expressed views about trade-offs between efficacy and experienced discomfort/adverse events caused by treatment. Reasons for non-compliance, such as adverse events or geographical and availability barriers, were discussed. Considerations related to accessibility and affordability were relevant from the patients' perspective.

CONCLUSIONS/SIGNIFICANCE: NTDs affect disadvantaged populations, often with little access to health systems. Engaging patients in designing adapted therapies could significantly contribute to the suitability of an intervention to a specific context and to compliance, by tailoring the product to the end-users' needs. This exploratory study identified preferences in a broad international patient spectrum. It provides methodological guidance on how patients can be meaningfully involved as stakeholders in the construction of a TPP of therapeutics for NTDs. CL is used as an exemplar, but the approach can be adapted for other NTDs.

摘要

背景

目标产品概况(TPP)有助于优化治疗药物、疫苗和诊断产品的设计和开发,为了实现预期效果,这些产品应符合用户的偏好和需求。然而,患者很少作为关键利益相关者参与 TPP 的制定。

方法

从巴西、哥伦比亚和奥地利招募了 33 名感染新世界利什曼原虫的皮肤利什曼病(CL)患者,采用最大变异方法,根据地理、社会人口和临床标准进行招募。使用患者母语进行半结构式访谈。将翻译成英文的转录本进行框架分析。我们将 CL 患者的疾病经历、偏好和期望与 DNDi(被忽视疾病药物研发倡议)为 CL 治疗制定的 TPP 相匹配。

主要发现

患者对治疗的偏好范围从特定的疗效和安全性终点到直接和显著的间接成本。受访者表达了对疗效和治疗引起的不适/不良反应之间权衡的看法。还讨论了不遵守治疗方案的原因,如不良反应或地理和供应障碍。从患者的角度来看,可及性和负担能力的考虑是相关的。

结论/意义:NTD 影响弱势人群,他们往往很少能获得卫生系统。让患者参与设计适应性疗法,可以通过将产品定制为最终用户的需求,显著提高干预措施对特定环境和合规性的适宜性。这项探索性研究在广泛的国际患者群体中确定了偏好。它提供了关于如何有意义地让患者作为利益相关者参与 NTD 治疗药物 TPP 构建的方法指导。CL 被用作范例,但该方法可以适应其他 NTD。

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