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Patients with RA receptive to, satisfied with IV treatment
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When it comes to biologic therapy options, patients with rheumatoid arthritis are generally open to, and express high satisfaction with, IV treatments, according to findings published in Arthritis Care & Research.
“One of the key factors influencing patient preference for biologic therapy is the route of administration (ie, IV or subcutaneous),” Lucas Grisanti, BA, of Buffalo Rheumatology, in Orchard Park, New York, and colleagues wrote. “Biologics generally exhibit comparable efficacy, despite differences in route of administration. Thus, patients’ and rheumatologists’ preferences for route of administration may play a role in driving the choice of biologic treatment; however, rheumatologists’ and patients’ perspectives on various routes of administration may differ.”
To analyze patients’ perceptions of IV and subcutaneous routes for biologic therapy, Grisanti and colleagues developed and distributed two surveys. The first, which assessed treatment preferences and compliance, was a 20-item questionnaire completed by 243 rheumatology patients at a suburban practice in the greater Buffalo area in New York, from January through March 2015. Participants included patients with RA, psoriatic arthritis, ankylosing spondylitis, lupus and other diseases, as well as both bio-naive patients and those who had been exposed to biologic therapies.
A second, online survey was distributed to nearly 10,000 patients assessing their experiences with IV infusion and the Janssen-sponsored BioAdvance support program. All of these patients had been treated with infliximab (Remicade, Janssen) at one of 192 Canadian clinics, and enrolled in the BioAdvance program, which provides support for individuals in Canada who are scheduled to receive IV infusions of infliximab, golimumab (Simponi, Janssen) or ustekinumab (Stelara, Janssen). A total of 1,598 participants, including 306 rheumatology patients, completed the second survey.
According to the researchers, 44% of participants in the first survey were bio-naive. Of those, 56% were open to either IV or subcutaneous treatment. Among bio-naive participants, women were more likely than men to express a preference, with 65% of women preferring IV therapy. In the second survey, 61% of rheumatology patients were bio-naive prior to enrolling in the BioAdvance program. Among this group, the median rating of IV favorability — on a 10-point scale, with higher numbers indicating greater favorability — was 5 prior to first infusion, but later increased to 9 following multiple treatment infusions.
“Results of both surveys reported here indicate that patients with inflammatory arthropathies generally have favorable perceptions of IV therapy,” Grisanti and colleagues wrote. “Based on the authors’ clinical experience, patient education and convenience appear to be factors driving the choice of treatment modality; bio-naive patients may be unaware of the option of IV biologic therapy or perceive at-home [subcutaneous] biologic therapy as a safer option than IV therapy.” – by Jason Laday
Disclosure: The researchers report that survey 2 was sponsored by Janssen. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Carrie Beach, BSN, RN
Grisanti and colleagues conducted two surveys that evaluated rheumatology patients’ perceptions regarding intravenous biologic treatments. The first survey was conducted in a private rheumatology practice and was aimed at evaluating patient preference regarding route of administration: subcutaneous (SC) or intravenous (IV).
The results indicated that the majority of patients, including biologic naïve patients, were open to trying either SC or IV treatments. Interestingly, the results also showed that a higher proportion of bio-naïve patients preferred IV to SC therapies. The cohort of the second survey consisted of patients enrolled in a patient support program that were already scheduled to receive IV biologic therapy. This study gauged patients’ opinions regarding favorability of IV treatment. Not surprisingly, results showed that the favorability increased after a patient had already received IV treatments.
In the past, studies have demonstrated a general patient preference for SC biologic therapies versus IV. The results of these two studies indicate that, more recently, patients are open to either IV or SC treatments. I think this study highlights how the patient perception of IV treatment has evolved over the past few years. I can remember a time when patients were terrified of infusions for a myriad of reasons, but there were also not many choices available via IV for the treatment of rheumatologic conditions.
With so many treatment options available now, I think it is extremely important that we have open discussions with our patients regarding their preferences for treatment. This allows for a more balanced decision-making process between patient and provider, which will hopefully lead to increased adherence and improved patient outcomes.
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Grisanti L, et al. Arthritis Care Res. 2018;doi:10.1002/acr.23758.
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