Feldman SR, Thyssen JP, Boeri M, Gerber R, Neary MP, Cha A, Hauber B, Cappelleri JC, Xenakis J, Leach C, Zeichner J. Preferences for topical treatments in patients with mild-to-moderate atopic dermatitis. Poster presented at the 31st EADV Congress; September 7, 2022. Milan, Italy.

INTRODUCTION & OBJECTIVES: Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by itching, dry skin, redness, inflammation, and/or exudation. Topical treatments for mild-to-moderate (M2M) AD may include emollients, corticosteroids, calcineurin inhibitors, and PDE4 inhibitors, which may vary in efficacy, safety, and dosage regimen. This study aimed to elicit preferences for attributes of treatments for M2M AD and to quantify their relative importance among adults, caregivers, and adolescents.

MATERIALS & METHODS: An online discrete-choice experiment (DCE) survey was administered in the United States to adults (aged 18 and older) and adolescents (aged 12 to 17) with M2M AD and caregivers of children (aged 3 months to 11 years) with M2M AD. Attributes were identified through prior qualitative research (Ervin et al., 2021). Severity was determined using the Patient Oriented Eczema Measure (POEM; higher scores indicating more severe AD; range, 0-28) and treatment history. Respondents were presented with 12 choice tasks, each involving a choice between 2 hypothetical topical AD treatments characterized by: efficacy (time until itch improves, time until skin becomes clear/almost clear), treatment-related adverse events (burning/itching sensation when medicine is applied, changes in skin color, changes in skin thickness/texture), formulation (cream or ointment), and frequency of application (once a day, twice a day, or once every other day). Data were analyzed using a random-parameters logit model to estimate preference weights used to calculate the conditional relative importance (CRI) of each attribute as the difference between the most and least preferred attribute levels. The CRIs across attributes sum to 100.

RESULTS: 300 adults with M2M AD (69% female; mean age, 53 years; mean POEM score, 10.5), 330 caregivers of children with M2M AD (children 49% female, mean age, 5.3 years; mean POEM score, 9.6), and 331 adolescents with M2M AD (48% female, mean age, 15 years; mean POEM score, 9.3) completed the DCE. Figure 1 presents the CRI of each attribute for all three populations. Avoiding a change in skin color (CRI: 29.0) and time until itch improves (CRI: 26.6) were most important to adults when choosing between hypothetical treatments, followed by time until skin becomes clear/almost clear (CRI: 17.8). Avoiding changes in skin thickness and texture (CRI: 9.8), avoiding burning or itching when medicine is applied (CRI: 7.9), and mode of administration (CRI: 5.8) were the next most important attributes. Frequency of administration (CRI: 3.0) was the least important attribute and did not have a statistically significant impact on adults’ treatment choice. Adolescent patients were much less concerned about changes in skin color than adult patients or caregivers, and caregivers were less concerned about achieving clear/almost clear skin than patients.

CONCLUSIONS: On average, adults with M2M AD identified change in skin color, time until itch improves, and time until skin becomes clear/almost clear as the most important AD treatment attributes. Adolescent patients were less concerned about changes in skin color. Frequency of application was not identified as the most important treatment attribute for any of the cohorts. These results suggest that physicians should consider age-relevant aspects of treatment preferences in discussions of treatment plans with patients and caregivers.

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