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Understanding the patient experience with carcinoid syndrome
Exit interviews from a randomized, placebo-controlled study of telotristat ethyl
Anthony, L., Ervin, C., Lapuerta, P., Kulke, M. H., Kunz, P., Bergsland, E., Hörsch, D., Metz, D. C., Pasieka, J., Pavlakis, N., Pavel, M., Caplin, M., Öberg, K., Ramage, J., Evans, E., Yang, Q. M., Jackson, S., Arnold, K., Law, L., & DiBenedetti, D. B. (2017). Understanding the patient experience with carcinoid syndrome: Exit interviews from a randomized, placebo-controlled study of telotristat ethyl. Clinical Therapeutics, (11). https://doi.org/10.1016/j.clinthera.2017.09.013
PURPOSE: Telotristat ethyl, an oral tryptophan hydroxylase inhibitor, is intended to treat carcinoid syndrome by reducing serotonin production. Telotristat ethyl was evaluated in TELESTAR, a Phase III study for patients who had carcinoid syndrome with at least 4 bowel movements (BMs) per day and who were receiving somatostatin analogue therapy. This interview substudy was conducted to provide insight into the patient experience in TELESTAR and to help understand whether reductions in BM frequency (the primary end point) and other symptoms were clinically meaningful.
METHODS: Participating sites were asked to invite (before randomization) all eligible patients to telephone interviews scheduled at the end of the double-blind treatment period. Patients and interviewers were blinded to treatment.
FINDINGS: All 35 interviewed participants reported diarrhea and/or excessive BMs at baseline. Patients reported that these symptoms negatively affected emotional, social, physical, and occupational well-being. Prespecified criteria for treatment response (achieving ≥30% reduction in BM frequency for at least 50% of the days) were met by 8 of 26 patients taking telotristat ethyl and 1 of 9 patients taking placebo. All 8 patients taking telotristat ethyl described clinically meaningful reductions in BM frequency and were very satisfied with the ability of the study drug to control their carcinoid syndrome symptoms. Overall, reports of being very satisfied were observed in 12 patients taking telotristat ethyl and 0 taking placebo.
IMPLICATIONS: Patient interviews revealed that TELESTAR patients, at baseline, were significantly affected by their high BM frequency. Patient reports of their clinical trial experience supported the significance of the primary end point and clinical responder analysis in TELESTAR, helping identify and understand clinically meaningful change produced by telotristat ethyl.
