Background Route and frequency of administration of treatment options may be an important differentiator between drugs that are used to treat RA and patient preferences may influence adherence to and outcomes of therapy.
Objectives The objective of this study was to assess the correlation between the fulfillment of patient preferences and clinical and patient reported outcomes.
Methods PANORAMA was a non-interventional, prospective, multicenter, cohort study. Patients were either biologic naïve or experienced who initiated/switched to anti-TNF at enrollment. Post physician's anti-TNF choice, patients completed a preferences questionnaire over attributes related to anti-TNF treatment. Satisfaction with treatment was assessed with the TSQM questionnaire and compliance (proportion of full doses/planned) was recorded via the use of a patient diary. Persistence was defined as the time period between first and last anti-TNF administration. The observational period was 12 months, with study visits every 3 months.
Results A total of 254 patients were enrolled in the study. The mean patient age was 58.3±13.4 years, 82.7% were female, 65.4% were biologic naïve and 66.1% had severe disease (DAS-28 ESR>5.1).The mean DAS-28 and HAQ-DI scores at enrollment were 5.5±1.1 and 1.4±0.6 respectively, while mean disease duration was 6.7±6.2 years with 53.2% of patients being seropositive (RF (+):49.2%, Anti-CCP (+): 40.5%). A monthly administration was most preferred by patients (65.7% vs. 20.1% for twice per month, 11.8% for once per week and 3.9% for twice per week), and the large majority of patients (75.2%) preferred the subcutaneous mode of administration. The mean compliance and 12-month persistence rates were 97.0% and 72.3% respectively. At 12 months, good EULAR response rate was achieved by 56.5% of patients and 40.8% were in DAS-28 remission. Univariate analysis demonstrated that fulfillment of patient preferences was correlated to good EULAR response (p<0.001), increased probability of being persistent (p=0.019) and satisfaction with treatment (p=0.063). Multivariate logistic regression analysis revealed that a good EULAR response was associated with satisfaction of patient preferences (OR 5.560, p<0.001), good patient knowledge of the disease (OR 1.327, p=0.006), absence of history of comorbidities (OR 2.42, p=0.014) and lower SJC (OR 1.10, p=0.021), whereas anti-TNF persistence at 12 months was associated (Cox regression analysis) with seropositivity (HR 0.566, p=0.047) and a high baseline ESR (>35 mm/h (HR 0.587, p=0.071)).
Conclusions In anti-TNF treated RA patients, fulfillment of expressed treatment preferences was independently associated with a good EULAR response and correlated with drug persistence at 12 months, emphasizing the importance of patient preferences in treatment outcomes.
Acknowledgements The study was funded by Merck Sharp & Dhome S.A., Greece
Disclosure of Interest None declared