Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Abstract

BackgroundBiological disease-modifying antirheumatic drugs (bDMARDs) used in second-line treatment of rheumatoid arthritis (RA) are administered parenterally. However, so-called targeted synthetic DMARDs (tsDMARDs) – developed more recently – offer alternative (ie, oral) administration forms in second-line treatment. Since bDMARDs and tsDMARDs can be regarded as equal in terms of efficacy, the present study examines whether such characteristics as route of administration drive RA patients’ treatment choice. This may ultimately suggest superiority of some second-line DMARDs over equally effective options, at least according to RA-patient preferences.ObjectiveThe current study assessed the importance of oral administration among other treatment characteristics differing between available second-line DMARDs for RA patients’ preferences using a discrete-choice experiment (DCE).Materials and methodsThe DCE involved scenarios of three hypothetical treatment options in a d-efficient design with varying levels of key attributes (route and frequency of administration, time till onset of drug effect, combination therapy, possible side effects), as defined by focus groups. Further patient characteristics were recorded by an accompanying questionnaire. In the DCE, patients were asked to choose best and worst options (best–worst scaling). Results were analyzed by count analysis and adjusted regression analysis.ResultsA total of 1,588 subjects completed the DCE and were eligible for final analyses. Across all characteristics included in the DCE, “oral administration” was most desired and “intravenous infusion” was most strongly rejected. This was followed by “no combination with methotrexate” being strongly preferred and “intake every 1–2 weeks” being strongly rejected. On average, levels of route of administration showed strongest influences on patients’ decisions in post hoc bootstrapping analysis.ConclusionAccording to the results, an oral DMARD that does not have to be combined with methotrexate and is not administered (only) every 1–2 weeks appears a highly favorable treatment option for patients with RA. DMARDs meeting these preferences may increase compliance and adherence in RA treatment.

Patient Perspectives on Intravenous Biologics for Rheumatologic Disease

“…Results from the previous literature on patient and physician preferences for biologic therapy suggest a disconnect in patient and physician perceptions . Results of the 2 surveys reported here, along with the results of previous patient preference studies may address this disconnect by providing physicians with information regarding patients’ attitudes and concerns around different rheumatology treatments. This understanding of the patient perspective may help guide physicians’ discussions with their patients about different biologic therapy options.…”

“…For RA patients with active disease despite conventional DMARDs, current recommendations do not specify a treatment of choice from among approved anti–tumor necrosis factor (anti‐TNF) inhibitors (e.g., adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) or the non‐TNF options (e.g., abatacept, anakinra, rituximab, sarilumab, tocilizumab, and tofacitinib) in some cases . The choice of biologic therapy for each patient is generally based on consideration of patient‐related factors, disease‐related factors, the mechanism of action of the prescribed medication, and patient preferences for treatment .

A general preference for subcutaneous biologic therapies has previously been reported among rheumatology patients. Results of the current surveys indicate that rheumatoid arthritis patients, including biologic‐naive patients, are generally open to intravenous or subcutaneous treatment. Patients receiving intravenous therapy express high satisfaction with this route of administration.

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Quality of life and patient preferences among Danish patients with ulcerative colitis – results from a survey study

“…In that study, however, short infusions (30-60 min) and long infusions (2-3 h) were preferred a little more and a little less, respectively, to the oral mode of administration. Alten et al 47 found that among patients with rheumatoid arthritis, oral tablets were significantly preferred to both IV infusions and SC injections. In the two studies, however, the mode of administration and frequency of administration were not combined, which might explain the differences in preference across the studies.…”

Patient preferences for rheumatoid arthritis treatments: results from the national cross-sectional LERACS study

“…In another US survey of 250 RA patients who had discontinued anti-TNF therapy, 41% cited injection experience (pain/burning/discomfort during or after injection, redness/swelling after injection, dislike of self-injection or of injection frequency, fear of needles) as an important reason for discontinuation 10. A German discrete-choice experiment performed in 1,588 RA patients found that “oral administration” and “no combination with methotrexate” were the most highly desired characteristics of a second-line DMARD, with “intravenous infusion” being among the most strongly rejected 11. The authors concluded that an oral DMARD excluding methotrexate is a highly favorable treatment option that may increase compliance and adherence in RA treatment.…”