Influence of Modifiable factors in PsA contributing to treat to target success (the IMPACT study)

themes

4, 3

Project overview

Around 30% of people with psoriasis will go on to develop a related inflammatory arthritis called psoriatic arthritis.  This can cause inflammation in the peripheral joints, tendons, spine and other musculoskeletal tissues and significant impairment of quality of life. A large European consortium of researchers called HIPPOCRATES has been funded to further research into psoriatic arthritis. Within this, Professor Coates is leading a 5-year project examining how to predict and potentially prevent the onset of PsA. This DPhil has been co-designed with members of another large consortium (PREFER) which is examining patient preferences in research.

This DPhil project will establish the acceptability of preventative treatment for PsA amongst people with psoriasis.  It will help us to design a future interventional study aiming to prevent the progression to psoriatic arthritis.

Whether people would be happy to join a preventative study is likely to depend on a lot of factors, Training will be provided in qualitative research techniques to lead focus groups of people with psoriasis.  This qualitative work will explore the different factors that would influence their choice about enrolling in a preventative study such as:

• Risk of developing arthritis
• Side effects of any medication/intervention
• Whether the medication also improves psoriasis
• What previous treatments people have received for psoriasis

Additional work with patients will explore individual and socio-economic barriers and enablers for people to enrol in a future study and the outcomes important to patients that should be included in a preventative study.

Following this work, with expertise from Dr Falahee and Dr Veldwijk, you will co-design a discrete choice experiment to measure patient’s preferences for preventative therapy.  This will explore patient preferences for the attributes of preventative treatments and calculate the minimum benefit levels that patients require given different levels of side effects.  This work will build on a threshold technique study that is currently being undertaken looking at these factors.  For example, the current study asks

In the discrete choice experiment we will build on these thresholds and give participants a choice between two different theoretical treatments to see which they would decide.  They will then be given two different treatment options, each with different side effects and doses.  People will also have an option to ‘opt out’ if they would not like to take either treatment.

For example:

“You have recently developed some pain in your joints.  Tests have shown that your risk of developing psoriatic arthritis in the next 2 years is 50%.  Your doctor has asked you to consider taking a treatment to reduce that risk for one year.  Which of these treatments would you pick?”.

This work will contribute directly to the design of a future trial aiming to test medications aiming to prevent the evolution from psoriasis to psoriatic arthritis.  You will be a key member of the international HIPPOCRATES consortium supporting international networking opportunities.