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Macey J, Kitchen H, Aldhouse NVJ, Edson-Heredia E, Burge R, Prakash A, King BA, Mesinkovska N. A qualitative interview study to explore adolescents' experience of alopecia areata and the content validity of sign/symptom patient-reported outcome (PRO) measures. Br J Dermatol 2021; 186:849-860. [PMID: 34811721 PMCID: PMC9305453 DOI: 10.1111/bjd.20904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The content validity (appropriateness and acceptability) of patient-reported outcome (PRO) measures for scalp hair loss, eyebrow loss, eyelash loss, nail damage and eye irritation has been demonstrated in adults with alopecia areata (AA) but not adolescents. OBJECTIVE To explore the content validity of the suite of AA PRO measures and accompanying photoguides in an adolescent sample. METHODS Semi-structured, 90-minute, combined concept elicitation and cognitive interviews were conducted face-to-face with adolescents who experienced ≥50% AA-related scalp hair loss. Transcripts underwent thematic and framework analysis. RESULTS Eleven adolescents (age 12-17 years, 55% female, 45% non-Caucasian/white) diagnosed with AA for 5.9 years (mean) participated. Participants had 69.6% scalp hair (mean) and current eyebrow (82%), eyelash loss (82%) and/or nail involvement (36%). Adolescents reported scalp, eyebrow and eyelash hair loss as their top three most bothersome signs/symptoms. Despite mostly accepting their AA, impacts related to visible areas of hair loss were prominent. Participants demonstrated good understanding and appropriate use of the PRO measures, and advocated including hair loss percentages alongside descriptive categories in the Scalp Hair Assessment PRO™. Results confirmed treatment success thresholds established with adults: achievement of ≤20% scalp hair loss, no/minimal eyebrow and eyelash loss, no/a little nail damage and eye irritation (PRO categories 0 or 1). CONCLUSIONS The Scalp Hair Assessment PRO™, PRO Measure for Eyebrows™, PRO Measure for Eyelashes™, PRO Measure for Nail Appearance™ and PRO Measure for Eye Irritation™ and accompanying photoguides are fit-for-purpose self-reported measures of AA signs/symptoms that are impactful to adolescents with AA.
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Affiliation(s)
- J Macey
- Clinical Outcomes Assessment, DRG Abacus (part of Clarivate), Bicester, UK
| | - H Kitchen
- ²Clinical Outcomes Assessment, DRG Abacus (part of Clarivate), Manchester, UK
| | - N V J Aldhouse
- ²Clinical Outcomes Assessment, DRG Abacus (part of Clarivate), Manchester, UK
| | | | - R Burge
- ³Eli Lilly and Company, Indianapolis, IN, USA.,Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - A Prakash
- ³Eli Lilly and Company, Indianapolis, IN, USA
| | - B A King
- ⁵Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - N Mesinkovska
- University of California Irvine, Department of Dermatology, Irvine, CA, USA
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King B, Kwon O, Mesinkovska N, Ko J, Dutronc Y, Wu W, McCollam J, Yu G, Holzwarth K, DeLozier A, Hordinsky M. LB785 Efficacy and safety of baricitinib in adults with Alopecia Areata: Phase 3 results from a randomized controlled trial (BRAVE-AA1). J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Burns LJ, Flanagan KE, Pathoulas JT, Ellison A, Mesinkovska N, Senna MM. Patient perspectives of the cumulative life course impairment of alopecia areata. Clin Exp Dermatol 2021; 46:935-936. [PMID: 33548059 DOI: 10.1111/ced.14597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 12/14/2022]
Affiliation(s)
- L J Burns
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - K E Flanagan
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - J T Pathoulas
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - A Ellison
- National Alopecia Areata Foundation, San Rafael, CA, USA
| | - N Mesinkovska
- National Alopecia Areata Foundation, San Rafael, CA, USA.,Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - M M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Burns LJ, Flanagan KE, Pathoulas JT, Ellison A, Mesinkovska N, Senna MM. Alopecia universalis: a patient's perspective of the cumulative life course impairment. Clin Exp Dermatol 2021; 46:1353-1354. [PMID: 33740296 DOI: 10.1111/ced.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- L J Burns
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - K E Flanagan
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - J T Pathoulas
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - A Ellison
- National Alopecia Areata Foundation, San Rafael, CA, USA
| | - N Mesinkovska
- National Alopecia Areata Foundation, San Rafael, CA, USA.,Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - M M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Wyrwich K, Kitchen H, Knight S, Aldhouse N, Macey J, Nunes F, Dutronc Y, Mesinkovska N, Ko J, King B. Development of the Scalp Hair Assessment PRO™ measure for alopecia areata. Br J Dermatol 2020; 183:1065-1072. [PMID: 32163589 PMCID: PMC7754291 DOI: 10.1111/bjd.19024] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Valid patient-reported outcome (PRO) measures are required to evaluate alopecia areata (AA) treatments. OBJECTIVES To develop a content-valid and clinically meaningful PRO measure to assess AA scalp hair loss with scores comparable with the five-response-level Alopecia Areata Investigator Global Assessment (AA-IGA™). METHODS A draft PRO measure was developed based on input from 10 clinical experts in AA. The PRO measure was cognitively debriefed, modified and finalized through two rounds of qualitative semistructured interviews with patients with AA who had experienced ≥ 50% scalp hair loss. Data were thematically analysed. RESULTS Adults (round 1: n = 25; round 2: n = 15) and adolescents aged 15-17 years (round 1: n = 5) in North America participated. All patients named scalp hair loss as a key AA sign or symptom. Patients demonstrated the ability to self-report their current amount of scalp hair using percentages. In round 1 not all patients interpreted the measurement concept consistently; therefore, the PRO was modified to clarify the measurement concept to improve usability. Following modifications, patients in round 2 responded without difficulty to the PRO measure. Patients confirmed that they could use the five-level response scale to rate their scalp hair loss: no missing hair, 0%; limited, 1-20%; moderate, 21-49%; large, 50-94%; nearly all or all, 95-100%. Almost all patients deemed hair regrowth resulting in ≤ 20% scalp hair loss a treatment success. CONCLUSIONS The Scalp Hair Assessment PRO™ is a content-valid, clinically meaningful assessment of distinct gradations of scalp hair loss for evaluating AA treatment for patients with ≥ 50% hair loss at baseline.
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Affiliation(s)
- K.W. Wyrwich
- Patient‐Focused Outcomes Center of ExpertiseEli Lilly and CompanyIndianapolisINUSA
| | - H. Kitchen
- Clinical Outcomes AssessmentDRG AbacusManchesterUK
| | - S. Knight
- Clinical Outcomes AssessmentDRG AbacusManchesterUK
| | | | - J. Macey
- Clinical Outcomes AssessmentDRG AbacusManchesterUK
| | - F.P. Nunes
- Lilly Bio‐MedicinesEli Lilly and CompanyIndianapolisINUSA
| | - Y. Dutronc
- Lilly Bio‐MedicinesEli Lilly and CompanyIndianapolisINUSA
| | - N. Mesinkovska
- University of California Irvine Dermatology Clinical Research CenterIrvineCAUSA
| | - J.M. Ko
- Stanford DermatologyStanford University School of MedicineStanfordCAUSA
| | - B.A. King
- Department of DermatologyYale School of MedicineNew HavenCTUSA
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Wyrwich KW, Kitchen H, Knight S, Aldhouse NVJ, Macey J, Nunes FP, Dutronc Y, Mesinkovska N, Ko JM, King BA. The Alopecia Areata Investigator Global Assessment scale: a measure for evaluating clinically meaningful success in clinical trials. Br J Dermatol 2020; 183:702-709. [PMID: 31970750 PMCID: PMC7586961 DOI: 10.1111/bjd.18883] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Content-valid and clinically meaningful instruments are required to evaluate outcomes of therapeutic interventions in alopecia areata (AA). OBJECTIVES To develop an Investigator's Global Assessment (IGA) to interpret treatment response in AA treatment studies. METHODS Qualitative interviews were conducted in the USA with expert dermatologists and with patients with AA who had experienced ≥ 50% scalp-hair loss. Thematic data analysis identified critical outcomes and evaluated the content validity of the new IGA. RESULTS Expert clinicians (n = 10) judged AA treatment success by the amount of scalp-hair growth (median 80% scalp hair). Adult (n = 25) and adolescent (n = 5) patients participated. Scalp-hair loss was the most bothersome AA sign/symptom for most patients. Perceived treatment success - short of 100% scalp hair - was the presence of ~ 70-90% scalp hair (median 80%). Using additional clinician and patient insights, the Alopecia Areata Investigator Global Assessment (AA-IGA™) was developed. This clinician-reported outcome assessment is an ordinal, static measure comprising five severity categories of scalp-hair loss. Nearly all clinicians and patients in this study agreed that, for patients with ≥ 50% scalp-hair loss, successful treatment would be hair regrowth resulting in ≤ 20% scalp-hair loss. CONCLUSIONS We recommend using the Severity of Alopecia Tool to assess the extent (0-100%) of scalp-hair loss. The AA-IGA is a robust ordinal measure providing distinct and clinically meaningful gradations of scalp-hair loss that reflects patients' and expert clinicians' perspectives and treatment expectations. What is already known about this topic? The Severity of Alopecia Tool is widely used to assess the extent of scalp-hair loss in patients with alopecia areata. Guidelines define treatment success as a 50% improvement in scalp hair, and clinical trials have used dynamic thresholds of 50% and 90%. However, there is no clinical consensus on these endpoints, and patient perspectives on treatment success are unknown. What does this study add? Through qualitative interviews with 10 expert dermatologists and 30 patients with alopecia areata who had experienced ≥ 50% scalp-hair loss, we developed the Alopecia Areata Investigator Global Assessment (AA-IGA™) to measure five clinically meaningful gradations of alopecia areata scalp-hair loss that reflects patients' and clinicians' perspectives and expectations of treatment success in alopecia areata treatment studies. What are the clinical implications of this work? The AA-IGA is a robust ordinal measure that can inform clinical evaluation of alopecia areata treatment outcomes. The AA-IGA can be used to determine clinically meaningful treatment success for alopecia areata, with success defined by patients and clinicians as reaching ≤ 20% scalp-hair loss. Linked Comment: Blome. Br J Dermatol 2020; 183:609.
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Affiliation(s)
- K W Wyrwich
- Patient-Focused Outcomes Center of Expertise, Eli Lilly and Company, Indianapolis, IN, USA
| | - H Kitchen
- Lilly Bio-Medicines, Eli Lilly and Company, Indianapolis, IN, USA
| | - S Knight
- Lilly Bio-Medicines, Eli Lilly and Company, Indianapolis, IN, USA
| | - N V J Aldhouse
- Lilly Bio-Medicines, Eli Lilly and Company, Indianapolis, IN, USA
| | - J Macey
- Lilly Bio-Medicines, Eli Lilly and Company, Indianapolis, IN, USA
| | - F P Nunes
- Clinical Outcomes Assessment, DRG Abacus, Manchester, UK
| | - Y Dutronc
- Clinical Outcomes Assessment, DRG Abacus, Manchester, UK
| | - N Mesinkovska
- Dermatology Clinical Research Center, University of California, Irvine, CA, USA
| | - J M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - B A King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
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Rambhia P, Tripathi R, Conic R, Murad A, Mesinkovska N, Piliang M, Bergfeld W. 616 Updates in therapeutics for pediatric alopecia areata: A systematic review with evidence-based analysis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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