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. 2020 Jan 16;15(1):e0227635.
doi: 10.1371/journal.pone.0227635. eCollection 2020.

Patient preferences for maintenance therapy in Crohn's disease: A discrete-choice experiment

Glen S Hazlewood  1 , Gyanendra Pokharel  2 , Robert Deardon  2   3 , Deborah A Marshall  1 , Claire Bombardier  4   5 , George Tomlinson  4 , Christopher Ma  6 , Cynthia H Seow  1 , Remo Panaccione  6 , Gilaad G Kaplan  1   6
Affiliations

Patient preferences for maintenance therapy in Crohn's disease: A discrete-choice experiment

Glen S Hazlewood et al. PLoS One. .

Abstract

Objective: To quantify patient preferences for maintenance therapy of Crohn's disease and understand the impact on treatment selection.

Methods: We conducted a discrete-choice experiment in patients with Crohn's disease (n = 155) to measure the importance of attributes relevant to choosing between different medical therapies for maintenance of Crohn's disease. The attributes included efficacy and withdrawals due to adverse events, as well as dosing and other rare risks of treatment. From the discrete-choice experiment we estimated the part-worth (importance) of each attribute level, and explored preference heterogeneity through latent class analysis. We then used the part-worths to apply weights across each outcome from a prior network meta-analysis to estimate patients' preferred treatment in pairwise comparisons and for the overall group of treatments.

Results: The discrete-choice experiment revealed that maintaining remission was the most important attribute. Patients would accept a rare risk of infection or cancer for a 14% absolute increased chance of remission. Latent class analysis demonstrated that 45% of the cohort was risk averse, either to adverse events or requiring a course of prednisone. When these preferences were used in modelling studies to compare pairs of treatments, there was a ≥ 78% probability that all biologic treatments were preferred to azathioprine and methotrexate, based on the balance of benefits and harms. When comparing all treatments, adalimumab was preferred by 53% of patients, who were motivated by efficacy, and vedolizumab was preferred by 30% who were driven by the preference to avoid risks. However, amongst biologic treatment options, there was considerable uncertainty regarding the preferred treatment at the individual patient level.

Conclusion: Patients with Crohn's disease from our population were, on average, focused on the benefits of treatment, supporting intensive treatment approaches aimed at maintaining remission. Important preference heterogeneity was identified, however, highlighting the importance of shared decision making when selecting treatments.

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Conflict of interest statement

Dr. Hazlewood, Dr. Pokharel, Dr. Deardon, Dr. Tomlinson and Dr. Ma have nothing to declare. Dr. Marshall has received honoraria and travel expenses from Abbvie, Pfizer, Novartis, and Johnson and Johnson for presentations and participation on advisory boards and has been a consultant for Merck. Dr. Bombardier holds a Pfizer Chair and a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care and has received grant support from Janssen, Pfizer, Amgen, Abbott/Abbvie Canada, BMS, Celgene, Eli Lilly, Fresenius Kabi, Hoffman La Roche, Sanofi, UCB, and Calea, has acted as a consultant for AstraZeneca, Abbott/Abbvie Canada and BMS, and has participated in advisory board meetings for Janssen, Pfizer, Amgen, and AstraZeneca. Dr. Panaccione has served as a speaker, a consultant and an advisory board member for Abbott Laboratories, Merck, Schering-Plough, Shire, Centocor, Elan Pharmaceuticals, and Procter and Gamble. He has served as a consultant and speaker for Astra Zeneca. He has served as a consultant and an advisory board member for Ferring and UCB. He has served as a consultant for Glaxo-Smith Kline and Bristol Meyers Squibb. He has served as a speaker for Byk Solvay, Axcan, Jansen, and Prometheus. He has received research funding from Merck, Schering-Plough, Abbott Laboratories, Elan Pharmaceuticals, Procter and Gamble, Bristol Meyers Squibb, and Millennium Pharmaceuticals. He has received educational support from Merck, Schering-Plough, Ferring, Axcan, and Jansen. Dr. Cynthia H. Seow has served as a speaker and participated in advisory board meetings for Janssen, Abbvie, Takeda, Shire and Ferring. Dr. Kaplan has received honoraria for speaking or consultancy from Abbvie, Janssen, Pfizer, and Takeda. He has received research support from Janssen, Abbvie, GlaxoSmith Kline, Merck, and Shire. He shares a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent 62/555,397. 7 Sept. 2017. This patent relates to the potential therapeutic effect of mirtazapine on immune mediated disease such as inflammatory bowel disease. However, mirtazapine is not directly studied in the current publication. This does not alter our adherence to PLOS ONE policies on sharing data.

Figures

Fig 1
Fig 1. Average importance of each attribute level.
Results are presented as utilities [median (95% credible interval)], which are scaled from +10 (strong preference) to– 10 (strong aversion). BID, twice daily; IV, intravenous; med, medication; sc, subcutaneous; Q2W, every 2 weeks; Q8W, every 8 weeks.
Fig 2
Fig 2. Relative importance of treatment attributes in the overall group and each of the two latent classes.
LCA, latent class analysis.
Fig 3
Fig 3. Predicted treatment preferences for each individual patient.
See this image and copyright information in PMC

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