Background Few research studies have investigated treatment (Tx) goals in rheumatoid arthritis (RA) from the patients’ (pts) perspective, including factors preventing achievement of Tx targets and reasons why pts tolerate sub-optimal disease control.
Objectives To identify barriers to Tx optimisation, using real-world data from the ArthritisPower registry. Secondary objectives were to understand pts’ Tx goals and why pts tolerate active disease.
Methods This was an observational, cross-sectional sub-study of pts in the ArthritisPower registry. Pts were aged ≥19 years, had physician-diagnosed RA, no change to Tx within 3 months of baseline, and had access to a computer/smartphone. Pt-reported outcomes (PROs) included pain, fatigue, sleep, physical function, and general health. Pts also completed an online survey on barriers to Tx escalation, and were classified into 3 groups based on physician and pt attitudes to Tx change (change not offered, change offered and accepted, change offered and rejected). Disease activity was reported using Routine Assessment of Patient Index Data 3 (RAPID3) scores.
Results 257 pts met the inclusion criteria (table 1). 195/257 (76%) pts were treated with DMARDs (non-biologic or biologic). 180/257 (70%) pts had high disease activity by RAPID3 (median 18.0 on 0–30 scale), of which only 67/180 (37%) were offered a Tx change at their last physician visit. Most of these pts accepted the Tx change (48/67 [72%]). There were few differentiating factors in demographics, RA-related features, and background therapy among pts who were offered a Tx change versus not. Most pts (33/44 [75%]) who intensified Tx did so because their symptoms remained bad or worsened, whereas only 16/44 (36%) changed because they did not reach pre-defined Tx goals. The most common reason (21/32 [66%]) for deciding not to change therapy was the rheumatologist’s satisfaction with the current therapy; pt concerns related to safety of the new therapy were less common (8/32 [25%]). There was a weak correlation between the RAPID3 score and pts’ self-reported perception of their own disease activity. The majority of pts (176/257 [69%]) valued being actively involved in making decisions with their doctor about Tx.
Conclusions Despite treat-to-target recommendations,1 about two-thirds of RA pts with high disease activity in this sample were not offered a Tx change by their rheumatologist. Only a minority changed because they had not met predefined targets for disease control. Pts commonly followed their rheumatologist’s decision that no Tx change was needed and placed greater importance on their doctor’s Tx goals than their own. These findings suggest that pts may be more deferential to their physicians’ satisfaction with poor RA disease control than is appropriate. Encouraging pts (not just physicians) to overcome the status quo by changing medications and striving for low disease activity/remission may be worthwhile, but traditional metrics (e.g. RAPID3) may not reflect the most relevant target for pts’ goals for therapy.
Reference  Stoffer M. Ann Rheum Dis2016;75(1):16–22.
Acknowledgements This study was funded by UCB Pharma. We thank the patients and their caregivers in addition to the investigators and their teams who contributed to this study. Editorial services were provided by Costello Medical.
Disclosure of Interest J. L. Stark Employee of: UCB Pharma, M. Yassine Employee of: UCB Pharma, W. B. Nowell: None declared, K. Gavigan: None declared, S. Ginsberg: None declared, M. S. Serna Employee of: UCB Pharma, J. R. Curtis Grant/research support from: Amgen, BMS, Janssen, Myriad Genetics, Lilly, Novartis, Pfizer, Roche and UCB Pharma, Consultant for: Amgen, BMS, Janssen, Myriad Genetics, Lilly, Novartis, Pfizer, Roche and UCB Pharma
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