Context Individuals with hypoparathyroidism experience a range of physical and cognitive symptoms and reduced quality of life (QoL) despite management with conventional therapy (active vitamin D and calcium). Objective This analysis investigated the long-term impact of parathyroid hormone (PTH) replacement therapy with palopegteriparatide (YORVIPATH®) on symptoms, daily functioning, and well-being in adults with chronic hypoparathyroidism. Associations between patient characteristics and changes in patient-reported outcomes (PROs) were also analyzed. Methods PaTH Forward was a phase 2 clinical trial of palopegteriparatide with a 4-week randomized, double-blind, placebo-controlled period followed by an open-label extension period lasting through trial week 266. PRO measures were collected at baseline, weeks 4, 12, 26, 58, and annually thereafter through the end of the trial. The Hypoparathyroidism Patient Experience Scales (HPES) assess disease-specific symptoms and impacts on functioning and well-being. The Short Form Health Survey (SF-36v2) measures general health-related QoL. Data were analyzed using descriptive statistics and Mixed Models for Repeated Measures. Results Palopegteriparatide treatment demonstrated significant improvements from baseline in disease-specific symptoms and impacts on daily functioning and well-being at week 12, which were sustained through week 110. Mean changes in PROs met thresholds for clinically meaningful within-patient improvement. Significant improvements in general health-related QoL were also shown in SF-36v2 scores. Results were generally similar across demographics and patient characteristics. Conclusion Through week 110 of the PaTH Forward trial, PTH replacement therapy with palopegteriparatide was associated with significant improvements in disease-specific symptoms and impacts on daily functioning and well-being, as well as general health-related QoL.

BackgroundThe cognitive difficulties experienced by individuals with narcolepsy type 1 (NT1), a rare and chronic neurological disorder, are understudied, with limited knowledge of their consequences in daily life. Here, we investigated the nature of cognitive difficulties and their consequences for daily life from the perspective of adults with NT1.MethodsIn-depth, qualitative interviews were conducted with adults diagnosed with NT1 residing in the United States. Participants were recruited through (1) a patient advocacy organization (via social media and website); (2) a professional market research firm; and (3) participant referrals. Individual interviews were conducted by telephone, following a semi-structured guide, and lasted approximately 90 min. Qualitative analysis used an adapted grounded theory approach to identify key conceptual themes related to cognitive difficulties and their impacts on daily life.ResultsOf 46 participants, most reported experiencing some cognitive difficulties, with the most common being trouble remembering and difficulty with focus or sustained attention. Most participants characterized their difficulties with cognition as moderate or severe and reported these occurring daily. The qualitative findings informed the development of a conceptual model depicting cognitive difficulties and their broad impact on functioning and well-being in adults with NT1.ConclusionCognitive difficulties in adults with NT1 are frequent, severe, and described as interfering with daily life activities and well-being. These data highlight a clear need to assess cognitive function in people with NT1 and identify treatments that address NT1-associated cognitive symptoms.

Abstract Background Achondroplasia, although rare, is the most common genetic form of skeletal dysplasia and is associated with a wide range of clinical manifestations and complications throughout the body. This study evaluated the psychometric measurement properties of the Achondroplasia Child Experience Measures (ACEMs), which were previously conceptually developed as condition-specific, observer-reported outcome measures to assess the signs (ACEM–OSM) and impacts (ACEM–Impact) of achondroplasia in children aged 2 to < 12 years. Methodology Data for the psychometric evaluation were from a non-interventional, observational study ( N = 200 (impacts) and N = 148 (signs)) and a phase 2, multicenter, double-blind, randomized, placebo-controlled, dose escalation interventional trial ( N = 57) of navepegritide (TransCon CNP) administered once weekly. The larger observational study sample size allowed for evaluation of distributional properties, test-retest reliability, and construct validity. Trial data was analyzed to confirm reliability and validity findings and evaluate responsiveness. Results Factor analysis and qualitative results identified six domains for the ACEM–Impact and one domain for the ACEM–OSM. The psychometric properties of both measures were found to be acceptable for reliability and validity for the intended use. An 8-item ACEM–OSM and a 25-item ACEM–Impact were finalized. Conclusions The ACEMs are reliable and valid measures of the signs and impacts of achondroplasia on children. Incorporation of these measures in clinical and research settings can aid in assessing new treatments and improve our understanding of the experience of those living with achondroplasia. Trial registration National Institutes of Health Clinicaltrials.gov (ID NCT04085523) and European Union Drug Regulating Authorities Clinical Trials database (EudraCT 2019-002754-22).

OBJECTIVE:The objective of this study was to develop a measure of eating behaviors in adults living with obesity or overweight. METHODS:Based on concept-elicitation (n = 53) and cognitive-debriefing (n = 15) studies, a draft eating behavior patient-reported outcome (EB PRO) measure was developed. Its psychometric properties were established using data from a 46-week clinical trial of an investigational antiobesity medication (n = 387). RESULTS:The final EB PRO comprised 12 items across two domains (i.e., "Desire to Eat" and "Capacity to Resist"; 6 items each) and a Total Eating Behavior score (0-48; higher scores worse). The EB PRO demonstrated good test-retest reliability (intraclass correlation coefficients > 0.7). Confirmatory factor analysis showed a comparative fit index of 0.98 with good internal consistency (Cronbach α > 0.7). The EB PRO generally exhibited moderate-to-large correlations with the Patient Global Impression of Severity questionnaire and Three-Factor Eating Questionnaire and weaker correlation with the 36-Item Short-Form Health Survey version 2 Physical Functioning scale. All EB PRO scores improved from baseline to week 46 (p < 0.0001), demonstrating sensitivity to change with therapy. Clinically meaningful thresholds were defined as eight- and four-point changes in Total Eating Behavior and domain scores, respectively. CONCLUSIONS:The EB PRO measure is a promising tool for assessing eating behaviors in people with obesity or overweight.

Purpose:Patient experience data capturing the patient voice is gaining increasing recognition across the drug development continuum for use in risk/benefit analysis to evaluate new drugs. The aim of this study was to delineate a prototype process for and then, following this process, develop questionnaires to rigorously assess patient-centric treatment preferences, using pediatric growth hormone deficiency (PGHD) treatment as a model. Patients and Methods:A literature review and concept elicitation interviews with clinical experts (n=5), caregivers of children with PGHD (n=15), and children with PGHD (n=15) were conducted. Most respondents were on injectable treatments with a small subsample on an investigational oral treatment. Data were analyzed based on adapted ground theory, and the GHD-Preference Measure (GHD-PRM), and GHD-Attribute Measure (GHD-ATM) were developed. These questionnaires were cognitively debriefed, refined, and finalized. Best practices for patient-reported outcome measure development and guidelines on assessing patient preferences were followed. Results:Beyond efficacy, some of the most important treatment aspects determining preference for caregivers were the ease of preparation/setup, convenience, and side effects. The most frequently reported reasons for missing, postponing, or changing their child's medication (eg, dosage) included travel/being away from home and flexibility of dosing. The most frequently reported treatment impacts on children's daily lives were travel/being away from home, social activities/relationships, and evening routine/schedule. Findings were generally similar between caregivers and children, and those on injectable vs oral treatment. The GHD-PRM is intended for use when treatment comparisons are appropriate; the GHD-ATM is intended for use when treatment comparisons are not available. Each has a caregiver and child version. Conclusion:The GHD-PRM and GHD-ATM can be considered disease-specific prototype preference and attribute questionnaires developed according to a rigorous patient-centric process. Novel, well developed preference measures such as these can provide valuable data to researchers, clinicians, regulators and reimbursement agencies.

Abstract Background Hypoparathyroidism is a rare endocrine disease frequently associated with serious physical and cognitive symptoms. This study’s purpose was to understand the impacts of the phase 3 PaTHway clinical trial treatment, TransCon PTH, on patients’ overall, physical, and cognitive hypoparathyroidism signs/symptoms and what patients consider meaningful improvement. Methods Individual telephone exit interviews were conducted with patients who recently completed the PaTHway trial blinded period. Using a semi-structured interview guide, interviews focused on trial treatment impact on hypoparathyroidism symptoms following the symptom list in the Hypoparathyroidism Patient Experience Scale-Symptom (HPES-Symptom). Meaningful changes in hypoparathyroidism symptoms were assessed with the Patient Global Impression of Severity (PGIS) and Patient Global Impression of Change (PGIC) measures. Interviewees were probed on the meaningfulness of reported changes in symptoms from prior to starting trial treatment to the past 2 weeks/current time. Interviews were audiotaped and transcribed. Transcripts were coded for emerging concepts and themes/subthemes covered in the interview guide based on an adapted grounded theory approach. Results Nineteen adults with hypoparathyroidism participated in interviews in the United States (n = 13, 68.4%) and Canada (n = 6, 31.6%). Marked improvements in physical and cognitive symptoms were described among trial treatment group respondents. The majority of participants who reported experiencing hypoparathyroidism physical symptoms pre-trial indicated symptom improvement with treatment, including muscle twitching (100%, n = 15), low energy (92.9%, n = 13), feeling tired (92.3%, n = 12), muscle weakness (92.9%, n = 13), tingling without numbness (84.6%, n = 11), trouble sleeping (92.3%, n = 12), muscle cramping (92.3%, n = 12), tingling with numbness (92.3%, n = 12), muscle spasms (100%, n = 12), and pain (90.9%, n = 10). Most participants who reported experiencing cognitive symptoms pre-trial reported symptom improvement with treatment, including difficulty finding the right words (86.7%, n = 13), difficulty concentrating (93.3%, n = 14), trouble remembering (92.9%, n = 13), trouble thinking clearly (85.7%, n = 12), and difficulty understanding information (83.3%, n = 10). Those in the placebo group reported limited or no improvement. The vast majority of participants affirmed that the improvements they experienced in symptom frequency on the PGIS/PGIC and HPES–Symptom were meaningful. Conclusions Findings indicate that TransCon PTH treatment improved participants’ physical and cognitive hypoparathyroidism symptoms in meaningful ways, while reducing the daily burden associated with conventional therapy. Trial registration NCT04701203 Registered: 06 January 2021. https://clinicaltrials.gov/study/NCT04701203?term=NCT04701203&rank=1.

INTRODUCTION:The Child Hemophilia Treatment Experience Measure (Child Hemo-TEM) was developed to capture the treatment burden experience of children with haemophilia (CwH). AIM:Describe the development of this novel haemophilia-specific measure. METHODS:Interviews were conducted with clinical experts, CwH and CwH's caregivers. Interviews were analysed according to adapted grounded theory principles. Based on the analysis, a preliminary measure was developed and debriefed. Psychometric analyses were performed according to an a priori analysis plan using data collected in a cross-sectional web survey and a final measure was generated. RESULTS:Interviews with four clinical experts, 25 CwH ages 8 to <12 years, and 25 caregivers of CwH <12 years were conducted. Concepts endorsed by ≥10% of CwH and caregivers were: adherence, ease of use, emotional impacts, physical impacts, treatment concerns, and interference with daily life. Cognitive debriefing assessments were conducted to ensure participant understanding and item relevance. Caregivers found the measure to be understandable, comprehensive, and relevant. However, several issues with CwH completing the measure were identified and it was decided to only develop an observer-reported outcome version. Data for psychometric validation was collected in a web survey (N = 187). Item reduction dropped 12 items. Factor analysis generated a single, 7-item, internally consistent (α = .855) factor, which consisted of items covering all relevant a priori concepts. The majority of a priori convergent and all known groups validity hypotheses were confirmed. CONCLUSIONS:The study findings provide evidence that the Child Hemo-TEM is a brief, well-designed, and valid and reliable measure of haemophilia treatment burden.

CONTEXT:Growth hormone deficiency (GHD) in children is currently treated with daily injections of GH, which can be burdensome for patients and their parents/guardians. Somapacitan is a GH derivative in development for once-weekly treatment of GHD.OBJECTIVE:This work aimed to assess the efficacy and safety of somapacitan, and associated disease/treatment burden, after 4 years of treatment and 1 year after switching to somapacitan from daily GH.METHODS:This long-term safety extension of a multicenter, controlled phase 2 trial (NCT02616562) took place at 29 sites in 11 countries. Patients were prepubertal, GH-naive children with GHD. Fifty patients completed 4 years of treatment. Patients in the pooled group received somapacitan (0.04, 0.08, 0.16 mg/kg/week) for 1 year, followed by the highest dose (0.16 mg/kg/week) for 3 years. Patients in the switched group received daily GH 0.034 mg/kg/day for 3 years, then somapacitan 0.16 mg/kg/week for 1 year. Main outcome measures were height velocity (HV), change from baseline in HV SD score (SDS), change from baseline in height SDS, disease burden, and treatment burden for patients and parents/guardians.RESULTS:Changes from baseline in HV and HV SDS were similar and as expected in both groups. Observer-reported outcomes showed that patients and parents/guardians seem to have experienced a reduced treatment burden when switching from daily GH to somapacitan. Most parents/guardians (81.8%) strongly/very strongly preferred somapacitan over daily GH.CONCLUSIONS:Somapacitan showed similar efficacy and safety in patients who continued somapacitan treatment and those who switched from daily GH to somapacitan. Once-weekly injections may lead to a reduced treatment burden relative to once-daily injections. A plain-language summary of this work is available.

PLD is a rare liver disease. Research on PLD health-related quality of life impacts is limited and mainly assessed using generic measures. Impacts may include limited mobility, decreased productivity, and emotional distress. To address this gap, the PLD-Impact (PLD-I), a disease-specific PROM, was developed.

Background: Despite treatment safety and efficacy advancements for children with hemophilia (CwH), home treatment can be complicated and burdensome. Treatment burdens are major contributing factors to adherence issues. The Child Hemo-TEM is a patient-centric outcome measure developed following the United States (US) Food and Drug Administration guidance for patient-reported outcome measure development. Designed to assess the treatment burden for CwH, the measure is a caregiver observer-reported outcome (ObsRO) measure where questions are answered by the caregiver about the child's treatment experience based on what the caregiver has seen, heard, or been told by the child. Aim: The purpose of this study was to psychometrically validate the Child Hemo-TEM ObsRO. Methods: Data was collected through a cross-sectional, web survey from a population of caregivers of CwH aged 2 to < 12 years in the US. The survey consisted of the Child Hemo-TEM, sociodemographic items, child's hemophilia medical history, and supporting items/measures required to assess the measure's psychometric properties. The survey took up to 45 minutes to complete and was administered at a single time point. To be eligible for the study, caregivers needed to be: aged ≥ 18 years; a caregiver of a male child with a diagnosis of severe to moderate hemophilia A or B, with a factor level of < 2%, with or without an inhibitor, and currently receiving either prophylactic or on-demand treatment; and living in the same residence as the child over the past 2 weeks. Recruitment was conducted by a patient advocacy group and a professional market research firm. Recruitment quotas were targeted to ensure a diverse population and mix of frequency of prophylactic treatment(s) and treatment administration type. All psychometric analyses were conducted following an a-priori statistical analysis plan, which included examination of measurement characteristics, item reduction, factor analysis, measure scoring, internal consistency, reliability, and validity. Results: Caregivers ( n=187) of CwH completed the web survey. The respondents were, on average, 37.8 years of age, mothers (84.0%), and predominantly White/Caucasian (74.3%). Twelve items were dropped from the validation-ready, 19-item measure: 5 items due to high ceiling effects at baseline (>50%) mirrored by the Rasch results and 1 item as it was highly correlated with a retained item. Further, as there were only a small number of children who self-injected, 6 items designed to assess child self-injection were removed. The remaining items underwent further psychometric testing. An exploratory factor analysis generated a single, 7-item factor. The Child Hemo-TEM was found to be internally consistent with a Cronbach's α of 0.855. A-priori validity hypotheses were adapted to match the final factor structure. Hypothesized associations were predominantly confirmed with a few exceptions. For convergent validity (Pearson's r significance set at α = 0.05), a few of the associations, although significant, were below 0.30 (Table 1). The Child Hemo-TEM was able to discriminate between levels of self-complaining about their infusions (p < 0.001), psychological stress reported by parent (p < 0.001), and ease/difficulty of their medication in its current form, among other variables. Based on psychometric findings and taking into consideration learnings from the concept elicitation during measure development, the brief, 7-item Child Hemo-TEM was finalized with 1 domain capturing information from all the hypothesized concepts of treatment concerns (3 items), adherence (1 item), physical impact (1 item), and interference with daily life (2 items) (Figure 1). A five-point Likert response scale with ranges from “Never” to “Always”, or a “Don't know” option, is used. Conclusion: The Child Hemo-TEM ObsRO has been found to be conceptually sound with adequate evidence to support its reliability and validity. Incorporation of the measure into both clinical and research settings will help assess the pediatric patient's experience of living with hemophilia as well as aid clinicians in tailoring treatments to patient characteristics and situations. Future studies are needed to assess test-retest reproducibility, sensitivity to change, and meaningful change thresholds of this new measure.

PLD is a rare condition in which multiple cysts develop in the liver. Approximately 20% of patients experience a high symptom burden. Limited patient-centered research exists for this condition, and much of the patient-reported data results from generic measures. To address this gap, a disease-specific PROM, the PLD-Symptom was developed.

Background: Satisfaction with insulin-delivery devices has been shown to improve treatment adherence, translating into better glycemic control. The Diabetes Pen Experience Measure (DPEM) is a new patient-reported outcome measure to evaluate patients’ experience when using an injection device. Methods: The DPEM was developed using literature review and concept elicitation interviews with clinical experts and patients. This led to a theoretical model and a draft measure of the diabetes pen experience, which was refined following cognitive debriefing. Validation entailed a web-based, noninterventional survey; psychometric analyses conducted according to a statistical analysis plan; and refinement and finalization of the DPEM and theoretical model. Results: In total, 42 patients participated in concept elicitation interviews. Analysis of the qualitative interviews resulted in a preliminary theoretical model. Based on this model, DPEM items were generated; the preliminary version of the DPEM contained 30 items. Following cognitive debriefing, the validation-ready version comprised 28 items. These were later reduced to 7 higher-order items owing to ceiling/floor effects. In total, 300 patients participated in the web-based validation study. The item statistics were all adequate. Item-to-item correlations were good. Item-to-total correlations displayed acceptable associations between each item against the rest of the items, with correlations of 0.68 to 0.79. The internal consistency was adequate, with a Cronbach’s alpha of 0.91. The DPEM is scored by summing the 7 item scores and transforming the sum onto a 100-point scale. Conclusion: The evidence presented supports the use of the DPEM in clinical trials to evaluate the patients’ experience with diabetes injection devices.

Abstract Background To capture the broad range of treatment burden issues experienced by adolescent and adult people with hemophilia (PWH), the Hemophilia Treatment Experience Measure (Hemo-TEM) was developed. We describe the development of this new hemophilia-specific patient-reported outcome (PRO) measure including concept elicitation, cognitive debriefing, and psychometric validation. Results Concept elicitation interviews were conducted with 5 clinical experts and 30 adult PWH in the United States (US). The qualitative analysis of these interviews and a review of the literature informed the PRO measure development. The project team reviewed concept endorsement rates and generated a 27-item preliminary version of the Hemo-TEM. Cognitive debriefing interviews were conducted to ensure participant understanding and item relevance in samples of (adolescent (n = 20) and adult (n = 14)) PWH in the US. The refined, validation-ready version of the Hemo-TEM included 30 items. Lastly, data from 3 clinical trials comprised the 4 analysis sets used for the psychometric validation with a sample size of N = 88. Item reduction dropped 4 items resulting in a final 26-item measure. Factor analysis generated 5 domains in the Hemo-TEM [injection difficulties (3 items), physical impact (6 items), treatment bother (7 items), interference with daily life (4 items), and emotional impact (6 items)] and a total score. All scores were reliable [internally consistent (0.84–0.88)]. For convergent validity, with the exception of one domain, all hypothesized associations were met. Preliminary sensitivity to change effect sizes were between − 0.30 and − 0.70. Meaningful change thresholds ranged from 6 points (physical impact and emotional impact) to 10 points (treatment bother) with 8 points for the Hemo-TEM total score. Conclusions Findings from the concept elicitation, cognitive debriefing, and psychometric validation phases provide evidence that the Hemo-TEM is a well-designed, valid, and reliable measure of the burden of hemophilia treatment, including treatment impact on adolescent and adult PWH.

The purpose of this study was to conduct cognitive debriefing (CD) interviews with adults diagnosed with chronic hypoparathyroidism (HP) to assess the content validity of the SF-36v2® Health Survey Acute (SF-36v2) measure in this population. CD interviews were conducted with adults with HP in the United States (US). Interviews were conducted by a trained moderator using a semi-structured interview guide, employing a think-aloud method in conjunction with verbal probing. Participants were asked whether each item was understandable, relevant, important, and sensitive to change in relation to HP. Additionally, comprehension of instructions, response options, and the appropriateness of a 1-week recall period was assessed. Sixteen adults with HP participated in individual CD telephone interviews. All items in the SF-36v2 were reported to be understood, relevant, important, and sensitive to change by at least half, and in most cases, by a strong majority of study participants. Most of the study sample confirmed comprehension of the instructions and the entire sample understood all response options. The study findings show that the items in the SF-36v2® are applicable to adults with HP. The overall high levels of endorsement of items provide strong evidence of the measure’s content validity for this population. The SF-36v2 is therefore recommended for usage in clinical trials examining adults with HP, although it is recommended that this generic measure be supplemented with disease-specific instruments such as the recently developed Hypoparathyroidism Patient Experience Scale—Symptom (HPES-Symptom) and Hypoparathyroidism Patient Experience Scale—Impact (HPES-Impact) measures.