Background In a survey we conducted last year, we compared treatment goals between DMARDs and biologics (BIO) treated patients. Our results showed BIO treated patients set higher treatment goals. Though goal setting, regardless of treatment, differs between individual patients, at that point it was unclear whether the patients’ individual goals had been achieved.
Objectives In order to evaluate satisfaction levels with treatment, we conducted another survey among the BIO treated patients who had envisioned higher treatment standards, and then studied to see if the results correlated with changes in disease activity.
Methods Two hundred and four outpatients treated with various biologics participated in the study; infliximab (53), etanercept (98), adalimumab (15), tocilizumab (35), and abatacept (3). All were treated at our hospital or satellite clinic, 81% were female, average age of the participants was 62. Our questionnaire addressed issues with pain and anxiety as well as satisfaction with current treatment. We evaluated patients before treatment with biologics and again at the time of the survey using DAS28, SDAI, mHAQ, FACE scale and PtVAS to study if satisfaction levels correlated with those values and/or change of those values. Further sub-analysis was also performed for each biologic.
Results Twenty-nine percent of participants were satisfied, 57% were somewhat satisfied, 11% were somewhat dissatisfied, and 3% were dissatisfied. In any of the preceding groups, there were no major differences in DAS28, SDAI, mHAQ, FACE scale, or PtVAS before the start of administration. However, at the time of the survey there was a tendency for values of each method to increase as patients’ satisfaction decreased, in particular with PtVAS values. This tendency was more prominent with greater statistical significance in the amount of changes from the initiation of treatment than at the time each patient was surveyed. Compared to the ‘satisfied’ group, the ‘dissatisfied’ group showed smaller changes in values with DAS28 (P <0.01), SDAI (P <0.05), mHAQ (P <0.005), FACE scale (P <0.001). With PtVAS values, satisfaction levels correlated more with the values at the time of the survey than the amount of changes. Although there wasn’t much difference in satisfaction levels among each BIO treatment, evaluation values and changes in the values of patients using etanercept showed the strongest correlation with the amount of change in satisfaction. Additionally, while tocilizumab treated patients showed correlation between their satisfaction levels with the value of SDAI, they did not with DAS28.
Conclusions With T2T, the goal is to reach remission, or at least, reach and maintain low disease activity. Patients’ satisfaction with treatment often depends on disease activity levels at the onset of treatment. The FACE scale was considered useful in representing the degree of satisfaction and could be used as a scale for indicating degree of goal attainment with T2T introduction. Although result using each evaluation method correlated with patients’ satisfaction levels, it is necessary to consider what method should be used depending on patients’ goal settings.
Keiko Funahashi & Tsukasa Matsubara, What RA patients expect of their treatment—discussion over the result of our survey, Clin Rheumatol, 10.1007/s10067-012-2048-7
Acknowledgements The authors wish to thank the patients who participated in the survey.
Disclosure of Interest None Declared
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