Background Available options of biological agents for the treatment of rheumatic disease have expanded in last years. As a consequence, treatment decision making becomes more complex . Understanding patients' preferences contributes to more informed decisions and more adequate therapeutic choices [1,2].
Objectives To assess rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients' preferences for biological agents (BA) in Spain.
Methods An observational, cross-sectional study was conducted in 41 public healthcare centers in Spain. RA, AS and PsA patients diagnosed ≥2 years, currently or previously (≤1 year ago) receiving BA for a minimum of 1 year participated. A literature review and 4 focus groups (rheumatologists, RA, AS and PsA patients) were undertaken to identify BA attributes and levels. Conjoint analysis was performed to define preferences. Eight scenarios resulted from combining 4 attributes: “Administration method” (ADMINISTRATION): Subcutaneous self-administration at home/ health care professional at hospital; “Pain relief and improvement of functional capacity” (RELIEF): Yes/ No; “Risk of adverse events” (AE): high/ low; and “duration of effect or time until perceiving the need for a new dose” (TIME): 1/2/4/8 weeks. A rank-ordered logit model was used to estimate partial utilities in each attribute for RA, AS and PsA patients, respectively. Relative importance (RI) was also calculated from partial utilities.
Results A total of 165 RA, 158 AS and 165 PsA patients were included [male=26%, 72%, and 56%; mean (SD) age=56 (12), 46 (11), and 50 (11) years; mean time from diagnosis=13 (8), 13 (9), and 12 (8) years, respectively]. All patients, irrespective of diagnosis (RA, AS and PsA), placed the highest importance on “RELIEF” (RI=49%, 50% and 48%, respectively) followed by “AE” (33%, 34% and 29%). AS and PsA patients assigned “ADMINISTRATION” and “TIME” the third (8% and 14%) and fourth (8% and 9%) importance place, respectively. In contrast, patients with RA placed “TIME” (10%) before “ADMINISTRATION” (8%). The ideal BA should relieve pain and improve functional capacity with a low risk of adverse events; allow a longer duration of effect, measured as time until need for a new dose is perceived (8 over 4 over 2 over 1 week) and be self-administered at home.
Conclusions The preferences for biological agents in patients with RA, AS and PA are fairly homogeneous in Spain. Effective pain relief is the perceived most crucial BA attribute. Differences appear when considering the administration method and treatment effect duration. These attributes should be particularly addressed in rheumatic disease treatments to better tailor to patients' choices.
Huynh TK, et al. Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis. Patient Prefer Adherence. 2014;8:93-99.
Hewlett S. et al. Values for function in rheumatoid arthritis: patients, professionals, and public. Ann Rheum Dis. 2001;60:928-33.
Disclosure of Interest None declared