Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients

Abstract

Background Preference assessments of patients with rheumatoid arthritis can support clinical therapeutic decisions for including biologic and targeted synthetic medicines to use. This study assesses patient preferences for attributes of second-line therapies and heterogeneity within these preferences to estimate the relative importance of treatment characteristics and to calculate the minimum benefit levels patients require to accept higher levels of side effects. Methods Between November 2018 to August 2019, patients with rheumatoid arthritis were recruited to a survey containing demographic and disease-related questions as well as a discrete choice experiment to measure their preferences for second-line therapies using biologics or Janus kinases inhibitors. Treatment characteristics included were route of administration, frequency of use, probability of mild short-term side effects, probability of side effects changing appearance, probability of psychological side effects, probability of severe side effects and effectiveness of treatment. Results A total of 358 patients were included in the analysis. A latent class analysis revealed three preference patterns: (1) treatment effectiveness as the single most important attribute, (2) route of administration as the most important attribute, closely followed by frequency of use and psychological side effects and (3) severe side effects as the most important attribute followed by psychological side effects. In addition, disease duration and mild side effects influenced the patients’ choices. Conclusion Respondents found either effectiveness, route of administration or severe side effects as the most important attribute. Patients noting effectiveness as most important were more willing than other patients to accept higher risks of side effects.

Management of Rheumatoid Arthritis: An Overview

“…bDMARDs or tsDMARDs are recommended if first-line therapy is not tolerated or is ineffective. tsDMARDs, including the class of Janus kinase inhibitors (JAKi), have the advantage of being orally administered [ 180 ].…”

Systematic review of quantitative preference studies of treatments for rheumatoid arthritis among patients and at-risk populations

“…‘minor side effects’) or the proportion of people having to discontinue treatment due to adverse events, in some cases giving examples of the type of side effects these categories might entail, but not singling out one specific side effect. One study of RA treatments referred to psychological side effects and side-effects related to physical appearance in addition to mild and serious side effects [ 23 , 24 ]. Presentation of side effects as risk of specific conditions versus categories of side effect severity did not appear to affect relative importance of risk attributes.…”

“…A benefit attribute was ranked higher than a risk attribute in both of the RA treatment studies with general public participants [ 42 , 43 ]. However, for the studies with RA patients a benefit attribute was relatively more important than a risk attribute in only eight of the 16 studies that assessed a benefit attribute and for which a rank ordering for relative importance was available [ 23 , 24 , 27 , 31 – 34 , 36 , 37 , 40 ]. In addition, for one study [ 25 , 26 ], the rank order differed for the two samples.…”

Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis

“…Therefore, it is essential for individualisation of treatment with DMARDs to identify what attributes patients with RA are willing to trade off, in order to increase patientcenteredness early on the treatment trajectory [4][5][6][7]. There is a large body of existing literature on patient preferences for RA treatment from a clinical standpoint [8][9][10]. Such studies focus mainly on endpoints relating to decreasing the number of tender and swollen joints [2].…”