Treatment Preferences for Subcutaneous Immunoglobulin Among Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy, Caregivers, and Physicians: A Discrete Choice Experiment.

内容摘要

Subcutaneous immunoglobulin (SCIG) is a recommended maintenance treatment option for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and could offer greater patient convenience than intravenous immunoglobulin (IVIG). We evaluated the burden of CIDP and assessed the value that patients with CIDP, caregivers, and physicians place on various attributes of SCIG treatment options. This was an online discrete choice experiment survey designed through targeted literature review and patient/caregiver/physician interviews, conducted in Germany, the UK, and&#xa0;the USA. The survey was administered to adults with CIDP who were stable on IVIG and/or receiving SCIG, and caregivers/physicians. Participants chose preferred treatment profiles comprising six SCIG treatment attributes with varying levels: chance of CIDP symptom worsening, treatment frequency, number of sites per infusion, time spent on infusion per month, chance of infusion site reaction, and infusion location. Subgroup analyses were also performed. A conditional logistic regression model estimated preference weight for each attribute. Overall, 146 patients, 52 caregivers, and 81 physicians completed the survey; mean (standard deviation) patient age was 58.1 (12.8) years; time since CIDP diagnosis was 8.8 (9.3) years; 98.6% had received IVIG, and 30.8% had received SCIG. Patients and caregivers experienced a substantial burden of disease that negatively impacted quality of life and work productivity. The most important factors in treatment decision-making were a lower chance of CIDP symptom worsening in 6&#xa0;months, less frequent treatment administration, and home infusion (all p&#x2009;<&#x2009;0.001 vs reference categories). Patients considered a lower chance (10% vs 20%) of symptom worsening and lower treatment frequency (every 3-4&#xa0;weeks vs weekly) as the most important SCIG attributes, accounting for 64.6% of the decision weight. There remains a substantial burden on patients and caregivers due to CIDP. Patients with CIDP highly valued efficacy and convenience when considering preferred SCIG options. Preference awareness may facilitate shared patient-physician decision-making.