Important determinants of the patient choice between TNF- vs. non-TNF Biologic disease-modifying anti-rheumatic drugs (DMARDs) for active rheumatoid arthritis (RA) - 13/06/20
, Haley Tornberg c, d, Susan M. Goodman c, dBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | In a qualitative study of 44 RA patients, we found that side effects and associated fear, comparative efficacy including the ability to prevent joint damage and doctor's opinion about the choice garnered 75% of the votes as the leading reasons for choosing between TNF vs. non-TNF biologics. |
• | Medication cost and comorbidity were less often cited reasons determining the choice of TNF vs. non-TNF biologics, contrary to our intuition. |
• | Identification of a patient perspective of the choice between TNF vs. non-TNF biologic for treating active RA can inform patient-physician discussions in the future. |
• | This knowledge will contribute to informative shared decision-making for RA treatment in clinical practice in the future. |
Abstract |
Objective |
To assess why patients choose TNF- versus non-TNF biologics for treating active rheumatoid arthritis (RA) after methotrexate-failure.
Methods |
Participants responded to the question “What sort of things help a patient decide the treatment choice between the two types of injectable biologics, TNF biologic versus non-TNF biologic, for treating active rheumatoid arthritis when methotrexate fails to control RA disease activity?” They nominated responses, discussed and then voted.
Results |
Forty-four patients participated in 10 nominal groups (Birmingham; n=6; New York City: n=4), who were predominantly female (86%), 68% white, with a mean age of 65 (standard deviation [SD], 12) years. Present/past DMARDs included methotrexate in 91%, glucocorticoids in 11%, and biologics and/or Jak-inhibitors in 68% of participants. Pain and fatigue were mild-moderate with means of 3.9 (SD, 2.5) and 4.3 (SD, 2.5), respectively, on 0-10 scale; mean morning joint stiffness was 1.3hours (SD, 2.1). The number of groups that nominated each response and total votes were as follows: (1) Side effects/fear of side effects: 10/10; 31% votes (82/264); (2) Efficacy/ability to reduce joint damage: 9/10; 30% votes (80/264); (3) Doctor's opinion, 6/10; 12% votes (32/264); (4) Cost, 7/10; 9% votes (25/264); (5) Other drugs/comorbidity, 4/10; 12% votes (31/264); (6) Experience of others/information-seeking/own research, 2/10; 2% votes (5/264); (7) Newness, 1/10; 2% votes (6/264); and (8) Convenience/frequency of use, 1/10; 1% votes (3/264).
Conclusions |
We identified the patient perspective of choice between TNF versus non-TNF biologic for treating active RA. This knowledge can help in informative shared decision-making in clinical care.
Le texte complet de cet article est disponible en PDF.Keywords : Rheumatoid arthritis, Patient preference, Treatment, Nominal group, Disease-modifying anti-rheumatic drugs, DMARDs, Biologic, TNF-biologic, Non-TNF biologic, Tumor necrosis factor
Plan
Vol 87 - N° 4
P. 307-313 - juillet 2020 Retour au numéro
Article précédent
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