Identifying the biologic closest to the ideal to treat chronic plaque psoriasis in different clinical scenarios: using a pilot multi-attribute decision model as a decision-support aid

Abstract

Objective:

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.

Research design and methods:

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.

Results:

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.

Limitation:

This study was conducted with a group of dermatologists attending a Wyeth-sponsored advisory board meeting.

Conclusions:

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.

Key words::

• Biologic therapy
• Decision-support techniques
• Multi-attribute decision model (MADM)
• Psoriasis

Transparency

Declaration of funding

The series of expert meetings from which these data were generated were financially supported by Wyeth Europa. The Wyeth Dermatology Advisory Board and Expert Panel comprises the following experts: Christina Antoniou (Greece), Nilgun Atakan (Turkey), Jonathan Barker (UK), Wolf-Henning Boehncke (Germany), José Manuel Carrascosa (Spain), Sergio Chimenti (Italy), Esteban Daudén (Spain), Elke de Jong (Netherlands), Fernando Gallardo (Spain), Alberto Giannetti (Italy), Giampiero Girolomoni (Italy), Mark Goodfield (UK), Christopher Griffiths (UK), Fabien Guibal (France), Pascal Joly (France), Andreas Katsambas (Greece), Mathilde Kemula (France), Brian Kirby (Ireland), Knud Kragballe (Denmark), Alexander Kreuter (Germany), Lars Iversen (Denmark), Jo Lambert (Belgium), Frank Nestle (UK), Jean-Paul Ortonne (France), Jörg Prinz (Germany), Lluís Puig (Spain), Mona Ståhle (Sweden), Siegfried Segaert (Belgium), Wolfram Sterry (Germany), Robert Strohal (Austria), Peter van de Kerkhoff (Netherlands).

Declaration of interests

F.G. has disclosed serving on a speakers’ bureau for Wyeth. L.I. has disclosed serving on a speakers’ bureau for Schering Plough; consulting or serving on expert/advisory boards with Wyeth and Abbott; and receiving research and educational grants from Wyeth and Schering Plough. L.P. has disclosed serving on speakers’ bureaus for Merck Serono, Wyeth, Schering Plough and Abbott; consulting or serving on expert/advisory boards with Merck Serono, Wyeth and Abbott; and receiving research and educational grants from Merck Serono, Wyeth, Schering Plough and Abbott. R.S. has disclosed serving on speakers’ bureaus for Wyeth, Astellas, Lohmann & Rauscher, Meda Pharmaceuticals, Menarini Pharmaceuticals, Stockhausen, and Smith & Nephew; having consulting or expert/advisory board agreements with Wyeth, Astellas, Lohmann und Rauscher, Smith & Nephew, Turimed, Helbo Photodynamic Systems, Brial, Pantec Biotechnologies, and Actelion; and receiving research and educational grants from Stockhausen, 3M-Woundcare, Smith & Nephew, Lohmann & Rauscher, Schülke & Mayr, and Enjo. P.W. received a fee for statistical advice and construction of the MADM model.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she has received research grants, is a consultant/advisor and on the speakers’ bureu for Amgen, Abbott, Centocor, Galderma and Stiefel. Peer Reviewer 2 has disclosed that he/she has no relevant financial relationships.

Acknowledgements

Editorial support for development of this manuscript was provided by Scott Chambers of Fishawack Communications Ltd, with funding provided by Wyeth Europa.