Background With the introduction of the biologics, decision-making for rheumatoid arthritis (RA) that affects up to 1% of the population has become even more complex. Assessing patient preferences for treatment in RA is a necessary step toward improving outcomes by ensuring satisfaction and adherence (1).
Objectives To examine patient preferences to route of administration of biologic DMARDs for RA treatment and to examine the same preferences for physicians and nurses assuming they were patients and needed the treatment.
Methods 107 RA patients treated with infliximab (IFX), etanacept (ETN), adalimumab (ADA), abatacept (ABA) or tocilizumab (TCZ), 35 RA patients treated with a synthetic DMARD and 30 rheumatologists (RH) and rheumatology nurses (RHN) were recruited from two rheumatology out-patient clinics in Copenhagen. All subjects filled out a questionnaire allowing choice of preferred route of administration of an arbitrary biological agent given the premise that effects and adverse effects were identical for the different choices. RH and RHN answered the questionnaire given that they themselves were to be treated. The following choices were available: IV infusion at the out-patient clinic (IVC) every 8 week, IVC every 4 week, two IVC 1 week apart once a year, subcutaneous self-injection at home (SCH) once a week, SCH every other week, SCH once a month and SCH with the help of a nurse. Subjects were asked to justify their preference by choosing one or two of the following statements: “It is easy to manage”, “It makes me feel safe”, “Due to time constraints”, “My walking is poor”, “I don’t like hospitals”, “I like to socialize at the hospital”.
Results The mean age (SD) was 56±14.0 years for patients, 53±14 years for DMARD patients, 49±9 years for RH and RHN. 61% of the patients and 73% of the RH and RHN were women. The mean transportation time to hospital (all subjects) was 35±33 (median 30, range 0-300) minutes. 50% (54/107) of the patients currently treated with a biologic would prefer SCH treatment. 41 patients were currently treated with ADA or ETN and 66 with IFX, TCZ or ABA. Of those treated with IVC, 71% (47/66) would prefer IVC treatment, 85% (35/41) of those treated with SCH would prefer SCH. 77% of the patient currently treated with synthetic DMARDs would prefer SCH. 87% (26/30) of all RH and RHN preferred SCH, and of these 77% preferred SCH once a month. The most frequent reason among patients for choosing IV treatment was “safety” (62%), followed by “easy to manage” (39%). The two most frequent reasons for choosing SCH treatment were “time constraints” and “easy to manage” (both 57%). Only 15 % of the patients with preference for IVC treatment favoured IVC once a month, 51% preferred infusion every 8 week and 34% two infusions once a year. Of the patients who preferred SCH treatment, 37% selected SCH once a month, 32 % once every 2 week, 14% once a week and 17% once a month with the help of a home nurse.
Conclusions The majority of the RA patients already treated with biologics preferred the route of administration they were used to. The majority of the patients not currently treated with a biologic preferred subcutaneous treatment at home. The feeling of safety was important to patients who preferred IV treatment. Health professionals as a group may be biased toward the use of subcutaneous treatment.
Barton JL. Patient Preference and Adherence 2009;3:335-44.
Disclosure of Interest None Declared
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