What matters most to patients when choosing treatment for mild-moderate asthma? Results from a discrete choice experiment.
asthma
asthma pharmacology
Journal
Thorax
ISSN: 1468-3296
Titre abrégé: Thorax
Pays: England
ID NLM: 0417353
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
17
11
2019
revised:
09
05
2020
accepted:
19
06
2020
pubmed:
29
7
2020
medline:
22
12
2020
entrez:
29
7
2020
Statut:
ppublish
Résumé
An as-needed combination preventer and reliever regimen was recently introduced as an alternative to conventional daily preventer treatment for mild asthma. In a subgroup analysis of the PRACTICAL study, a pragmatic randomised controlled trial of budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild asthma, we recently reported that about two-thirds preferred as-needed combination preventer and reliever therapy. The aim of this study was to determine the relative importance of attributes associated with these two asthma therapies in this subgroup of participants who indicated their preferred treatment in the PRACTICAL study. At their final study visit, a subgroup of participants indicated their preferred treatment and completed a discrete choice experiment using the Potentially All Pairwise RanKings of all possible Alternatives method and 1000minds software. Treatment attributes and their levels were selected from measurable study outcomes, and included: treatment regimen, shortness of breath, steroid dose and likelihood of asthma flare-up. The final analysis dataset included 288 participants, 64% of whom preferred as-needed combination preventer and reliever. Of the attributes, no shortness of breath and lowest risk of asthma flare-up were ranked highest and second highest, respectively. However, the relative importance of the other two attributes varied by preferred therapy: treatment regimen was ranked higher by participants who preferred as-needed treatment than by participants who preferred maintenance treatment. Knowledge of patient preferences for treatment attributes together with regimen characteristics can be used in shared decision-making regarding choice of treatment for patients with mild-moderate asthma. ACTRN12616000377437.
Sections du résumé
BACKGROUND
An as-needed combination preventer and reliever regimen was recently introduced as an alternative to conventional daily preventer treatment for mild asthma. In a subgroup analysis of the PRACTICAL study, a pragmatic randomised controlled trial of budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild asthma, we recently reported that about two-thirds preferred as-needed combination preventer and reliever therapy. The aim of this study was to determine the relative importance of attributes associated with these two asthma therapies in this subgroup of participants who indicated their preferred treatment in the PRACTICAL study.
METHODS
At their final study visit, a subgroup of participants indicated their preferred treatment and completed a discrete choice experiment using the Potentially All Pairwise RanKings of all possible Alternatives method and 1000minds software. Treatment attributes and their levels were selected from measurable study outcomes, and included: treatment regimen, shortness of breath, steroid dose and likelihood of asthma flare-up.
RESULTS
The final analysis dataset included 288 participants, 64% of whom preferred as-needed combination preventer and reliever. Of the attributes, no shortness of breath and lowest risk of asthma flare-up were ranked highest and second highest, respectively. However, the relative importance of the other two attributes varied by preferred therapy: treatment regimen was ranked higher by participants who preferred as-needed treatment than by participants who preferred maintenance treatment.
CONCLUSIONS
Knowledge of patient preferences for treatment attributes together with regimen characteristics can be used in shared decision-making regarding choice of treatment for patients with mild-moderate asthma.
TRIAL REGISTRATION NUMBER
ACTRN12616000377437.
Identifiants
pubmed: 32719055
pii: thoraxjnl-2019-214343
doi: 10.1136/thoraxjnl-2019-214343
doi:
Substances chimiques
Bronchodilator Agents
0
Budesonide, Formoterol Fumarate Drug Combination
0
Terbutaline
N8ONU3L3PG
Types de publication
Clinical Trial, Phase III
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
842-848Investigateurs
Andrew Corin
(A)
Liz Dronfield
(L)
Colin Helm
(C)
Tracy Paterson
(T)
Bhuwan Poudel
(B)
Davitt Sheahan
(D)
Pamela Sheahan
(P)
Christina Baggott
(C)
Richard Beasley
(R)
Irene Braithwaite
(I)
Alexandra Eathorne
(A)
Stefan Ebmeier
(S)
James Fingleton
(J)
Daniela Hall
(D)
Jo Hardy
(J)
Matire Harwood
(M)
Mark Holliday
(M)
Claire Houghton
(C)
Saras Mane
(S)
John Martindale
(J)
Karen Oldfield
(K)
Janine Pilcher
(J)
Donah Sabbagh
(D)
Philippa Shirtcliffe
(P)
Jenny Sparks
(J)
Alexandra Vohlidkova
(A)
Mathew Williams
(M)
Patrick Collins
(P)
Summer Hassan
(S)
Annika Lam
(A)
Claudette Lionnet
(C)
Barney Montgomery
(B)
Liz Smaill
(L)
Elena Bayly-McCredie
(E)
Chris Millar-Coote
(C)
Dean Millar-Coote
(D)
Jim Reid
(J)
Anna Samuel
(A)
Robert J Hancox
(RJ)
Mark Weatherall
(M)
Helen K Reddel
(HK)
Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: CB reports personal fees from AstraZeneca and Novartis. PH co-owns and cocreated the 1000minds software used in this study, which was created for the purpose of supporting elements of the methodology explained herein and which is made available to many academics (to date, more than 2000 researchers and students worldwide), including for the present study for free. RJH reports grants from AstraZeneca and Boehringer Ingelheim; and personal fees from Menarini. JKH reports personal fees from AstraZeneca. RB reports grants from Genentech, AstraZeneca, GlaxoSmithKline; and personal fees from AstraZeneca and Theravance. HKR reports grants from AstraZeneca and Novartis; personal fees from AstraZeneca, GlaxoSmithKline, Merck, Novartis, Teva, Mundipharma, and Boehringer Ingelheim; and is chair of the Global Initiative for Asthma scientific committee. JF reports grants from AstraZeneca, GlaxoSmithkline, and Genentech; and personal fees and non-financial support from AstraZeneca and Boehringer Ingleheim.