Background

Physician surveys on hereditary angioedema (HAE) management in 2010 and 2013 revealed important trends in HAE care.

Objective

To evaluate current HAE management and the impact of new treatment options on physician practice patterns over time.

Methods

During June and July 2019, 5382 physicians were contacted by means of postal mail to complete a 47-question survey; 177 responded (3%).

Results

Across the 3 surveys, the home replaced the emergency department as the most typically reported setting for HAE attack treatment (54.3% vs 11.6% in 2010 and 32.5% in 2013; P < .001). Physicians reported C1 esterase inhibitor (C1-INH) as the most typically prescribed long-term prophylactic treatment (LTP) (60.0% vs 20.4% in 2010 and 56.7% in 2013; P < .001). Subcutaneous LTP medications were most typically prescribed over intravenous (C1-INH, 41.4%; subcutaneous lanadelumab, 21%; intravenous C1-INH, 18.6%). Danazol, the most frequently prescribed LTP treatment, dropped to 6.4% (55.8% in 2010 and 23.4% in 2013; P < .001). The strongest nonefficacy factor influencing clinician treatment choice changed over time, with cost and (or) insurance coverage increasing to 43.7% (from 24.4% in 2010 and 40.5% in 2013; P = .001), whereas the concern over adverse effects dropped to 16.2% (from 55.8% in 2010 and 29.5% in 2013; P < .001). Physician-reported patient satisfaction remains high, with only 1.5% of physicians indicating patients are not satisfied with treatment.

Conclusion

The US physician survey data reflect improvements in the HAE management in recent years. Therapeutic advances in HAE have led to reported higher rates of home treatment of HAE attacks, reduced concern for adverse treatment effects, and high levels of patient satisfaction.

中文翻译：

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遗传性血管性水肿的当前医疗管理

背景

医师在2010年和2013年对遗传性血管性水肿（HAE）管理的调查显示，HAE护理的重要趋势。

客观的

评估当前的HAE管理以及随着时间的推移，新的治疗方案对医师执业方式的影响。

方法

在2019年6月和7月期间，通过邮寄方式联系了5382位医生以完成47个问题的调查; 177回应（3％）。

结果

在这三项调查中，家庭取代急诊室，成为最常报告的HAE攻击治疗环境（54.3％比2010年的11.6％和2013年的32.5％；P <.001）。医师报告C1酯酶抑制剂（C1-INH）是最典型的处方长期预防性治疗（LTP）（60.0％比2010年的20.4％和2013年的56.7％；P <.001）。皮下注射LTP药物最常见的是静脉注射（C1-INH，占41.4％；皮下lanadelumab，占21％；静脉内C1-INH，占18.6％）。最常用的LTP药物达那唑降至6.4％（2010年为55.8％，2013年为23.4％; P<.001）。影响临床医生治疗选择的最强非疗效因素随时间而改变，成本和（或）保险覆盖率从2010年的24.4％和2013年的40.5％增加到43.7％（P  = .001），而对不良反应的关注下降到16.2％（2010年为55.8％，2013年为29.5％；P <.001）。医师报告的患者满意度仍然很高，只有1.5％的医师表示患者对治疗不满意。

结论

美国医师调查数据反映了近年来HAE管理方面的改进。HAE的治疗进展已导致报道了HAE发作的家庭治疗率更高，对不良治疗效果的担忧减少以及患者满意度较高。