Patient and rheumatologist perspectives on tapering DMARDs in rheumatoid arthritis: a qualitative study

Abstract

Objectives To understand the perspectives of patients and rheumatologists for tapering DMARDs in RA. Methods Using semi-structured interview guides, we conducted individual interviews and focus groups with RA patients and rheumatologists, which were audiotaped and transcribed. We conducted a pragmatic thematic analysis to identify major themes, comparing and contrasting different views on DMARD tapering between patients and rheumatologists. Results We recruited 28 adult patients with RA (64% women; disease duration 1–54 years) and 23 rheumatologists (52% women). Attitudes across both groups towards tapering DMARDs were ambivalent, ranging from wary to enthusiastic. Both groups expressed concerns, particularly the inability to ‘recapture’ the same level of disease control, while also acknowledging potential positive outcomes such as reduced drug harms. Patient tapering perspectives (whether to and when) changed over time and commonly included non-biologic DMARDs. Patient preferences were influenced by lived experiences, side effects, previous tapering experiences, disease trajectory, remission duration, and current life roles. Rheumatologists’ perspectives varied on timing and patient profile to initiate tapering, and were informed by both data and clinical experience. Patients expressed interest in shared decision making (SDM) and close monitoring during tapering, with ready access to their healthcare team if problems arose. Rheumatologists were generally open to tapering (not stopping), though sometimes only when requested by their patients. Conclusion The perspectives of patients and rheumatologists on tapering DMARDs in RA vary and evolve over time. Rheumatologists should periodically discuss DMARD tapering with patients as part of SDM, and ensure monitoring and flare management plans are in place.

Preferences for COVID-19 Vaccination in People With Chronic Immune-Mediated Inflammatory Diseases

“…It is common that patient preferences, including inflammatory arthritis, are more often associated with sociodemographic characteristics, rather than disease characteristics (22). Patient preferences are shaped by their environment, peer groups, life roles and past experiences (23,24). Respectful, open communication around vaccines will help providers understand their patients' preferences, and address concerns.…”

Perspectives of Pediatric Rheumatologists on Initiating and Tapering Biologics in Patients with Juvenile Idiopathic Arthritis: A Formative Qualitative Study

“…The interviews were completed by two researchers (TP and GC), either in-person or through videoconference. The semi-structured interview guide was developed by the research team and was in part based on a similar study in adult rheumatoid arthritis [23]. No additional piloting was completed for this study, although the guide was updated by the research team, which included pediatric rheumatologists, to include prompts related to the pediatric population (e.g.…”

Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs

“…Recent reviews on RA patient preferences for down titration (15,16) identified several qualitative and mixed-methods studies (17)(18)(19)(20)(21). An additional Canadian study published since these reviews assessed preferences of patients and rheumatologists for tapering both biologic and non-biologic therapy (22). Common themes identified in the qualitative work included a desire amongst some patients to reduce medication burden but a fear of flaring, and concern about the ability to successfully recapture disease control.…”