ILD

Patient preferences should guide SSc-ILD treatment choices: study


New research involving patients with a form of interstitial lung disease (ILD) has highlighted the relevance of shared decision-making on treatment choices in clinical practice.

An international team carried out what they claim to be the first study to quantitatively assess patient preferences for treatment attributes in systemic sclerosis-associated interstitial lung disease (SSc-ILD), given the wide variation between therapies and differing perspectives on them.

First they identified seven SSc-ILD treatment attributes mode of administration, shortness of breath, skin tightness, cough, tiredness, risk of gastrointestinal adverse events, and risk of serious and non-serious infections – and then asked patients (231) to choose between two alternatives defined by various levels of attribute severity.

The results, published in the journal Rheumatology, showed that patients significantly preferred twice-daily oral treatments and 6-12 monthly infusions (p<0.001 for each), and that treatment choices were primarily influenced by risk of gastrointestinal (GI) side effects (relative attribute importance [RAI] 25%) or risk of infections (RAI 20%).

The research also revealed that from the patient perspective, improvements in shortness of breath (RAI 18%) and type and severity of cough (RAI 14%) were each of more importance than an improvement in skin tightness (RAI 8%).

With regard to benefit-risk trade-offs, patients were willing to accept an extra 21% risk of GI side effects if it meant frequency of infusions would be cut from monthly to 6-12 monthly, or an additional 15% higher risk if switching to an oral twice daily regimen.

An extra 28% risk of GI adverse events was considered acceptable if it meant that patients’ persistent cough was easier to tolerate, while a 37% higher risk was deemed acceptable if it meant breathlessness would only be experienced during routine activities as opposed to at rest as well.

The authors said patients in the study had “established preferences, placed high importance on avoiding AEs, and were willing and able to make trade-offs between attributes when considering treatment options,” which provides “a solid foundation for shared decision-making in routine clinical practice”.

While the study did have limitations, such as a low response rate and no data on patient characteristics, its results “can help inform discussions between patients and physicians regarding risks and benefits,” of SSc-ILD treatment, and “knowledge about preferences can also help tailor information materials to support informed decision-making,” they concluded.

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