Psoriasis patients’ willingness to accept side-effect risks for improved treatment efficacy

Abstract

Background: Previous studies suggest that efficacy is more important than side-effect risks to psoriasis patients. However, those studies did not consider potentially fatal risks of biologic treatments. Objective: To quantify the risks patients are willing to accept for improvements in psoriasis symptoms. Methods: Adults with a self-reported physician diagnosis of psoriasis were recruited through the National Psoriasis Foundation. Using a discrete-choice experiment, patients completed a series of nine choice questions, each including a pair of hypothetical treatments. Treatments were defined by severity of plaques, body surface area (BSA), and 10-year risks of tuberculosis, serious infection and lymphoma. Results: For complete clearance of 25% BSA with mild plaques, respondents (n = 1608) were willing to accept a 20% (95% confidence interval: 9–26%) risk of serious infection, 10% (5–15%) risk of tuberculosis and 2% (1–3%) risk of lymphoma. For complete clearance of 25% BSA with severe plaques, respondents were willing to accept a 54% (48–62%) risk of serious infection, 36% (28–49%) risk of tuberculosis and 8% (7–9%) risk of lymphoma. Limitations: Respondents were asked to evaluate hypothetical scenarios. Actual treatment choices may differ. Conclusion: Respondents were willing to accept risks above likely clinical exposures for improvements in psoriasis symptoms. Individual risk tolerances may vary.

• Benefit-risk
• discrete-choice experiment
• maximum acceptable risk
• psoriasis
• risk tolerance
• tumor necrosis factor blocker

Acknowledgments

The authors would like to thank Joel M. Gelfand and the National Psoriasis Foundation for reviewing the survey instrument, and to the latter for assistance in recruiting their members to participate in the study. Valuable input into the study design was provided by Christine Poulos of RTI Health Solutions. Research support was provided by Vikram Kilambi who was an employee of RTI Health Solutions at the time of the study. We would especially like to thank the members of the National Psoriasis Foundation who participated in the study.

Joann Hettasch, PhD, of Arbor Communications, Inc., Ann Arbor, MI, provided editorial services in the development of this manuscript.

Declaration of interest

Johnson, Yang and Hauber were employees of RTI Health Solutions at the time this study was conducted. Kauf was an employee of the University of Florida at the time of the study. Kauf received research contracts from RTI Health Solutions, Novartis, and GlaxoSmithKline at the time this research was conducted. This study was funded by AbbVie through a research contract with RTI Health Solutions.

Kimball has served as consultant and/or investigator to AbbVie, Amgen and Janssen, and received grants and/or fellowship from Janssen.

Sundaram, Bao, Okun and Mulani are employees of AbbVie and may own AbbVie stock or stock options.

All authors contributed to the study concept, interpreting the data, revising the manuscript for important intellectual content, and final approval of the version to be submitted. In addition, Kauf, Johnson, Yang, and Sundaram contributed substantially to the design of the study and acquired the data. Johnson and Yang conducted the statistical analysis. Kauf drafted the manuscript.