AB1129 PATIENTS AND PHYSICIANS TREATMENT PREFERENCES FOR SYSTEMIC LUPUS ERYTHEMATOSUS: A COMPARATIVE ANALYSIS OF COMPLEMENTARY DISCRETE CHOICE EXPERIMENTS
Authors: M. Piga, L. Quartuccio, F. Atzeni, M. Callori, A. Doria, G. Emmi, F. Franceschini, M. Gerosa, M. Mosca, P. Pasqualetti, R. Pelissero, G. D. Sebastiani, F. Conti, M. Govoni
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic Lupus Erythematosus (SLE) is a heterogeneous, inflammatory, chronic autoimmune disease presenting various complexities in both diagnostic procedures and therapeutic interventions. By integrating shared decision-making into the SLE management approach, healthcare providers can empower patients to actively participate in their care, fostering improved adherence to treatment plans and overall outcomes. <h3>Objectives:</h3> This study aims to enhance shared-decision making by investigating patient preferences alongside physicians' preferences regarding SLE treatment features. It involves integrating and comparing clinical priorities with patient perspectives. <h3>Methods:</h3> A board consisting of 11 clinicians experts in SLE, 2 patient representatives and a statistician specializing in DCE, reached a consensus on conducting complementary DCEs. The goal is to investigate whether physician and patient preferences align while maintaining consistent attributes and levels. This approach provides a direct assessment of relative preferences and hypothetical treatment approaches in SLE. The DCE methodological approach is commonly used to measure the relative importance assigned to treatment attributes, offering valuable insights into the perceptions of treatment decision-making for both clinicians and patients. The parameter estimates from the model were interpreted as relative preference weights (PWs), indicating the average relative preference for one attribute level over other levels (i.e., the relative strength of utility for each attribute level). The mean PWs were used to calculate the relative importance (RI) of each attribute. A separate sample size calculation for the DCEs was conducted, following the Orme's rule-of-thumb, and simulations were performed using Sawtooth Software Lighthouse Studio (9.14.2). <h3>Results:</h3> 95 clinicians (57% females, 71% rheumatologists) involved in the care of patients with SLE, with a median age of 45 years (range 31-71), participated in the physician-based DCE, and 410 patients with SLE (95% females) with a median age 50 years (range 18-80) participated in the patient-based DCE. In both group of respondents, the most important attribute were related to the "probability of worsening after 12 months of treatment" (RI=22%) and, in the physician-based DCE, this was synonymous with the "progression of organ damage after 12 months" (RI=41%) (Figure 1). For patients, the second most important attribute was the reduction of glucocorticoid dose after 6 months. Patients (RI=19%) and physicians (RI=11%) both prioritized the short-term goal of tapering prednisone to ≤5mg/day. However, physicians place greater preference (RI=19%) to the "reduction in disease activity levels after 6 months" while, surprisingly, "time to achieve a satisfactory clinical response to treatment" held the least importance for patients (RI=9%) (Figure 2). Significant differences between the two respondents groups were observed regarding the route of drug administration, with patients assigning greater priority (15%) compared to physicians (RI=7%). Notably, patients were willing to accept intravenous administration as long as it resulted in a reduction in the glucocorticoid dosage. <h3>Conclusion:</h3> This is the first DCE study involving patients and physicians to inform shared-decision making. The results will play a crucial role in aligning clinician priorities with patient's values and preferences, considering their individual circumstances. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> This work was supported with an unconditional grant by AstraZeneca Italy. <h3>Disclosure of Interests:</h3> <b>None declared.</b>