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. 2021 Apr;11(2):599-613.
doi: 10.1007/s13555-021-00508-w. Epub 2021 Mar 9.

Development of the Alopecia Areata Patient Priority Outcomes Instrument: A Qualitative Study

Randall Winnette  1 , Susan Martin  2 , Nimanee Harris  3 , Linda S Deal  4
Affiliations

Development of the Alopecia Areata Patient Priority Outcomes Instrument: A Qualitative Study

Randall Winnette et al. Dermatol Ther (Heidelb). 2021 Apr.

Abstract

Introduction: Although alopecia areata (AA) profoundly impacts patients' physical appearance, emotional state, and daily activities, no treatment approved for AA currently exists. Patient-reported outcome (PRO) instruments currently used to capture patients' AA experiences do not meet the requirements to support claims of treatment benefit as described in the US Food and Drug Administration's 2009 PRO guidance. Our objective was to explore the consequences and priority treatment outcomes among individuals with AA and develop a PRO measure consistent with regulatory requirements that assesses these priorities and represents clinical benefit from the AA patient perspective.

Methods: Targeted literature and instrument reviews informed an initial concept set. Concept elicitation interviews with 20 adults with AA confirmed the relevance and importance of the initial concepts, identified additional relevant concepts, and informed an AA consequence model. Thematic analysis yielded a draft item pool, which was evaluated through two iterative rounds of cognitive debriefing interviews with 16 patients with AA (9 adults; 7 adolescents).

Results: Hair loss was the primary consequence of importance to patients with AA. Patients emphasized the need to differentiate hair loss by location: scalp, eyebrows, eyelashes, and body. Consequences of AA include difficulty conducting daily activities, particularly outdoor activities and exercise, and emotional impacts such as sadness, frustration, and negative self-image. Following cognitive debriefing interviews, 11 items were included to form the Alopecia Areata Patient Priority Outcome (AAPPO), assessing AA-related symptoms and impacts over the past week.

Conclusions: The AAPPO is a novel, content-valid PRO that captures the consequences of AA of the highest priority to patients.

Keywords: Activity; Alopecia areata; Consequence; Development; Emotional; Hair loss; Impact; Patient-reported outcome; Qualitative; Symptom.

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Figures

Fig.1
Fig.1
Alopecia Areata Consequence Model. The alopecia areata consequence model was developed iteratively. A literature and instrument review informed the initial list of concepts for the model, which was updated based on results from qualitative interviews with adults and adolescents with alopecia areata. Concepts with a green box correspond to items that were ultimately included in the Alopecia Areata Patient Priority Outcomes instrument
See this image and copyright information in PMC

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