Patients with hereditary angioedema prefer daily oral treatment over periodic injections
Key takeaways:
- Patients in the study had a mean of 26.8 years since their diagnosis.
- Effectiveness in preventing attacks and in reducing attack severity were the most important factors in choosing treatment.
BOSTON — Patients with hereditary angioedema preferred daily pills over periodic subcutaneous injections for prophylactic care, according to a poster at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
By understanding patient preferences, health care providers can tailor individualized treatment plans, Daniel Soteres, MD, MPH, a physician with Asthma & Allergy Associates in Colorado Springs, Colorado, said during his presentation.
“Understanding patient prophylaxis options is important for shared decision-making,” Soteres said.
Researchers recruited 150 adults (mean age, 47.1 years; 81% women) with hereditary angioedema (HAE) from online panels. With a mean of 26.8 years since diagnosis, 77% had type 1 HAE, 18% had type 2 and 5% had HAE with a normal C1 inhibitor.
“These are patients who have had experience with the disease,” Soteres said.
All the patients had received long-term prophylaxis (LTP), on-demand treatment or both or had experienced one or more attacks within the previous 3 months. Also, 72% were taking a non-HAE medication as well, with 95% of them taking a pill or tablet.
The patients were asked to use best-worst scaling to assess preferences for LTP among 16 attributes identified from qualitative interviews with patients with HAE, with ratio-scaled relative importance scores ranging from 0 to 100.
“In this situation, a score of 20 would be twice as good as a score of 10,” Soteres said.
In choosing treatment, priorities for patients included effectiveness in preventing attacks (16.9), effectiveness in reducing attack severity (16.1), location of administration (9.2), side effects (8.7) and out-of-pocket costs (8.3).
Other drivers in treatment choice included financial support from the pharmaceutical company (8.1), long-term risks (6.8), convenience or ease of use (6.3), administration route (6.1), doctor recommendations (3.6), mechanism of action (3.2) and dosing frequency (2.7).
“Administration and convenience were more than twice as important as dosing frequency,” Soteres said.
Patients also were asked to choose between two hypothetical and experimentally designed LTP options in a series of choice tasks as part of a discrete choice experiment. Choices included oral and subcutaneous administration, with variations based on dosing frequency, average number of attacks and change in severity of attacks.
When presented with treatments of equal efficacy, 60% of patients said they would prefer once-daily oral treatment, and 40% said they would prefer subcutaneous injections twice a week.
“The preference remained the same regardless of the attack frequency,” Soteres said.
Preferences for oral treatment persisted compared with subcutaneous dosing once every 2 weeks (54% vs. 46%), once every month (54% vs. 46%), once every 2 months (53% vs. 47%) and once every 3 months (52% vs. 48%).
Specifically, 52% of patients preferred subcutaneous dosing once every 6 months over once daily oral dosing.
Soteres noted that the study’s limitations include its recall bias and its potential lack of generalizability to the larger population of patients with HAE.
“In conclusion, effectiveness is the top driver of LTP treatment preference in this population,” Soteres said, adding that patients preferred daily oral LTP treatment over subcutaneous dosing even with doses every 3 months.
“Understanding patients’ LTP preferences helps us in the shared decision-making model,” he said.