P154 Patient perceptions and preferences regarding systemic medicines for moderate-to-severe eczema

Abstract

BEACON is a UK-wide, head-to-head, platform randomized controlled trial comparing the effectiveness, tolerability and cost-effectiveness of ciclosporin, methotrexate, dupilumab and abrocitinib in treating moderate-to-severe eczema. It includes a nested qualitative study. Our aim was to gain insight into treatment experiences and patient preference. Trial participants were invited to a qualitative interview where views on systemic medication were explored. These were recorded, transcribed and thematically analysed. Overall, 38 trial participants consented to an interview, with roughly equal numbers per treatment arm. Generally, while some interviewees had preferences for newer medicines, an almost equal number had no preference ‘so long as treatments work’. Preferences often reflected incomplete or fragmented reasoning. Newer medicines were thought to have a targeted action, while older ones indiscriminately ‘affect the whole immune system’. Sometimes participants linked targeted action with better efficacy, or fewer side effects. When considering ‘standard’ systemic medicines, ciclosporin was thought to be quick acting, but participants were aware that its use was time limited, and they were worried about stopping taking it. Participants tended to be wary of the side effects of methotrexate and worried about its effect on short- and long-term fertility. Dupilumab was generally thought to have fewer side effects than ‘standard’ medications. Participants seemingly had less know­ledge about abrocitinib. Some reported they had been given information on side effects but could not recall any they were worried about. Others remembered serious side effects but did not feel they were at risk or felt they had been reassured. Many had concerns over short-term effects such as nausea. For all treatments, participants were unaware and concerned about longer-term medication plans. Many were frustrated that they had been unaware of systemic medicines prior to the trial. Better understanding of patient knowledge and perceptions around systemic medicines will support shared care decision making and the transferability of the BEACON trial results.