Patient Preferences for Biologicals in Psoriasis: Top Priority of Safety for Cardiovascular Patients

Marthe-Lisa Schaarschmidt; Christian Kromer; Raphael Herr; Astrid Schmieder; Diana Sonntag; Sergij Goerdt; Wiebke K Peitsch

doi:10.1371/journal.pone.0144335

Patient Preferences for Biologicals in Psoriasis: Top Priority of Safety for Cardiovascular Patients

PLoS One. 2015 Dec 3;10(12):e0144335. doi: 10.1371/journal.pone.0144335. eCollection 2015.

Authors

Marthe-Lisa Schaarschmidt¹, Christian Kromer¹, Raphael Herr², Astrid Schmieder¹, Diana Sonntag², Sergij Goerdt¹, Wiebke K Peitsch¹

Affiliations

¹ Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
² Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Abstract

Patients with psoriasis are often affected by comorbidities, which largely influence treatment decisions. Here we performed conjoint analysis to assess the impact of comorbidities on preferences of patients with moderate-to-severe psoriasis for outcome (probability of 50% and 90% improvement, time until response, sustainability of success, probability of mild and severe adverse events (AE), probability of ACR 20 response) and process attributes (treatment location, frequency, duration and delivery method) of biologicals. The influence of comorbidities on Relative Importance Scores (RIS) was determined with analysis of variance and multivariate regression. Among the 200 participants completing the study, 22.5% suffered from psoriatic arthritis, 31.5% from arterial hypertension, 15% from cardiovascular disease (myocardial infarction, stroke, coronary artery disease, and/or arterial occlusive disease), 14.5% from diabetes, 11% from hyperlipidemia, 26% from chronic bronchitis or asthma and 12.5% from depression. Participants with psoriatic arthritis attached greater importance to ACR 20 response (RIS = 10.3 vs. 5.0, p<0.001; β = 0.278, p<0.001) and sustainability (RIS = 5.8 vs. 5.0, p = 0.032) but less value to time until response (RIS = 3.4 vs. 4.8, p = 0.045) than those without arthritis. Participants with arterial hypertension were particularly interested in a low risk of mild AE (RIS 9.7 vs. 12.1; p = 0.033) and a short treatment duration (RIS = 8.0 vs. 9.6, p = 0.002). Those with cardiovascular disease worried more about mild AE (RIS = 12.8 vs. 10, p = 0.027; β = 0.170, p = 0.027) and severe AE (RIS = 23.2 vs. 16.2, p = 0.001; β = 0.203, p = 0.007) but cared less about time until response (β = -0.189, p = 0.013), treatment location (β = -0.153, p = 0.049), frequency (β = -0.20, p = 0.008) and delivery method (β = -0.175, p = 0.023) than others. Patients' concerns should be addressed in-depth when prescribing biologicals to comorbid patients, keeping in mind that TNF antagonists may favourably influence cardiovascular risk.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents / adverse effects
Anti-Inflammatory Agents / therapeutic use*
Biological Products / adverse effects
Biological Products / therapeutic use*
Cardiovascular Diseases / complications*
Dermatologic Agents / adverse effects
Dermatologic Agents / therapeutic use*
Female
Humans
Male
Middle Aged
Patient Preference*
Patient Safety*
Psoriasis / complications
Psoriasis / drug therapy*
Risk Factors
Young Adult

Substances

Anti-Inflammatory Agents
Biological Products
Dermatologic Agents

Grants and funding

The study was funded by the young scientists’ program of the German network “Health Services Research Baden-Württemberg” of the Ministry of Science, Research and Arts in collaboration with the Ministry of Employment and Social Order, Family, Women and Senior Citizens, Baden-Württemberg (grant to Marthe-Lisa Schaarschmidt).