Priorities when deciding on participation in early-phase gene therapy trials for Duchenne muscular dystrophy: a best–worst scaling experiment in caregivers and adult patients | Orphanet Journal of Rare Diseases | Full Text

Priorities when deciding on participation in early-phase gene therapy trials for Duchenne muscular dystrophy: a best–worst scaling experiment in caregivers and adult patients | Orphanet Journal of Rare Diseases | Full Text

Orphanet Journal of Rare Diseases

Priorities when deciding on participation in early-phase gene therapy trials for Duchenne muscular dystrophy: a best–worst scaling experiment in caregivers and adult patients

• Ryan S. Paquin,
• Ryan Fischer,
• Carol Mansfield,
• Brennan Mange,
• Katherine Beaverson,
• Annie Ganot,
• Amy Strong Martin,
• Carl Morris,
• Colin Rensch,
• Valeria Ricotti,
• Leo J. Russo,
• Alesia Sadosky,
• Edward C. Smith and
• Holly L. PeayEmail authorView ORCID ID profile

Orphanet Journal of Rare Diseases201914:102

https://doi.org/10.1186/s13023-019-1069-6

©  The Author(s). 2019

• Received: 27 November 2018
• Accepted: 17 April 2019
• Published: 9 May 2019

Abstract

Purpose

Several gene therapy trials for Duchenne muscular dystrophy initiated in 2018. Trial decision making is complicated by non-curative, time-limited benefits; the progressive, fatal course; and high unmet needs. Here, caregivers and patients prioritize factors influencing decision making regarding participation in early-phase gene therapy trials.

Methods

We conducted a best-worst scaling experiment among U.S. caregivers and adults with Duchenne (N = 274). Participants completed 11 choice sets, choosing features they cared about most and least when deciding whether to participate in a hypothetical gene therapy trial. We analyzed the data using sequential conditional logistic regression.

Results

Participants prioritized improved muscle function in trial decision making. Concerns about participation limiting later use of gene transfer and editing were also important, as were improved lung and heart function. Low risk of death fell near the middle. Participants cared least about muscle biopsies and potential for randomization to placebo. Adults with Duchenne and caregivers of non-ambulatory children significantly prioritized improved lung function compared to caregivers of ambulatory children.

Conclusion

Our data demonstrate prioritization of anticipated benefits and opportunity costs relative to potential harms and procedures in gene therapy trial decision making. Such data inform protocol development, education and advocacy efforts, and informed consent.

Keywords

• Gene therapy
• Duchenne muscular dystrophy
• Stated preference
• Best-worst scaling