Treatment Mode Preferences in Rheumatoid Arthritis: Moving Toward Shared Decision-Making

Abstract

Purpose: Current knowledge of the reasons for patients' preference for rheumatoid arthritis (RA) treatment modes is limited. This study was designed to identify preferences for four treatment modes, and to obtain in-depth information on the reasons for these preferences.

Patients and methods: In this multi-national, cross-sectional, qualitative study, in-depth interviews were conducted with adult patients with RA in the United States, France, Germany, Italy, Spain, Switzerland, the United Kingdom, and Brazil. Patients' strength of preference was evaluated using a 100-point allocation task (0-100; 100=strongest) across four treatment modes: oral, self-injection, clinic-injection, and infusion. Qualitative descriptive analysis methods were used to identify, characterize, and summarize patterns found in the interview data relating to reasons for these preferences.

Results: 100 patients were interviewed (female, 75.0%; mean age, 53.9 years; mean 11.6 years since diagnosis). Among the four treatment modes, oral administration was allocated the highest mean (standard deviation) preference points (47.3 [33.1]) and was ranked first choice by the greatest percentage of patients (57.0%), followed by self-injection (29.7 [27.7]; 29.0%), infusion (15.4 [24.6]; 16.0%), and clinic-injection (7.5 [14.1]; 2.0%). Overall, 56.0% of patients had a "strong" first-choice preference (ie, point allocation ≥70); most of these patients chose oral (62.5%) vs self-injection (23.2%), infusion (10.7%), or clinic-injection (3.6%). Speed and/or ease of administration were the most commonly reported reasons for patients choosing oral (52.6%) or self-injection (55.2%). The most common reasons for patients not choosing oral or self-injection were not wanting to take another pill (37.2%) and avoiding pain due to needles (46.5%), respectively.

Conclusion: These data report factors important to patients regarding preferences for RA treatment modes. Patients may benefit from discussions with their healthcare professionals and/or patient support groups, regarding RA treatment modes, to facilitate shared decision-making.

Keywords: drug administration; patient perspective; qualitative research; surveys.

Conflict of interest statement

PCT has received research grants from Eli Lilly, Galapagos, and UCB; and is a consultant for AbbVie, Eli Lilly, Galapagos, Gilead, and Pfizer Inc. NB is a consultant for Amgen, Eli Lilly, Grunenthal, Pfizer Inc, Roche, and Sanofi; reports personal fees from GSK and from Global Alliance for Patient Access, and is International Liaison Officer for EULAR. TMB, DW, and OO-A are employees of RTI Health Solutions, who were paid consultants to Pfizer Inc in connection with the development of this manuscript. JW, CC, PD, DPdL, DG, and LF are employees and shareholders of Pfizer Inc. AJK is a shareholder of Novartis; a consultant for AbbVie, Boehringer Ingelheim, Flexion, Genzyme, Janssen, Pfizer Inc, Regeneron, Sanofi, SUN Pharma, and UCB; a member of speakers’ bureaus for Celgene, Flexion, Genentech, Genzyme, Horizon, Ironwood, Merck, Novartis, Pfizer Inc, Regeneron, and Sanofi; and President of Altoona Center for Clinical Research. He also reports personal fees from Amgen, personal fees from Gilead, personal fees from GSK, outside the submitted work. CZ has received research grants from Amgen, Biogen, Eli Lilly, Merck, Novartis, Pfizer Inc, and Sanofi; and is a member of speakers’ bureaus for Amgen, Eli Lilly, Pfizer Inc, and Sanofi. The authors report no other conflicts of interest in this work.

© 2020 Taylor et al.

Figures

Figure 1

(A) 100-point allocationa means and (B) first-choice treatment mode preferenceb (N=100). Notes:aPatients were asked, “Assuming equal effectiveness, safety, and cost, if you had 100 points to assign across these four modes of administration to reflect your preferences, how would you allocate these points?”. bA patient’s first-choice mode was the mode with the most points allocated; percentages sum to 104% because four patients provided ties for their first-choice mode; these tied modes were counted twice in the percentages (oral and self-injection [n=3]; oral and infusion [n=1]).

Figure 2

(A) Strength of first choices (N=100) and (B) mode preferences among strong first choices (N=56).

Figure 3

Most commona reasonsb for choosing and not choosing oral administration, self-injection, infusion, and clinic-injection as the most-preferred mode. Illustrative patient quotations for these reasons are listed in Tables S3 and S4. Notes:aReported by ≥25% of patients. bPatients were asked about how they had assigned their 100 points to the modes of administration: Why is your first-choice mode your first choice? Why is that important to you? What else makes it your first choice? Why is your second/third/fourth choice so far/close in preference to your first/second/third choice? What do you like about your second/third/fourth-choice mode? What do you dislike about your second/third/fourth-choice mode? What else, if anything, is related to your first-choice mode being your most preferred way to take your RA treatment? Do you think that your past experiences with treatments for RA or treatments for any other conditions affect your preference for your first-choice mode? Like what? Abbreviations: n, number of patients giving reason; N, number of patients choosing that mode; RA, rheumatoid arthritis.