Physicians weigh efficacy, patient expectations when offering intra-articular drugs for OA
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Physicians often weigh the uncertain efficacy of injectable drugs, and patients’ expectations, before offering intra-articular injections for osteoarthritis, according to findings published in Arthritis Care & Research.
“Intra-articular injection therapies, most commonly corticosteroid injections, have been a cornerstone of knee OA management and are recommended in treatment guidelines,” Lindsey A. MacFarlane, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “Additional therapies, including hyaluronic acid products (HA), platelet-rich plasma and emerging, potentially disease-modifying OA treatments, are also delivered via IA injection.”
“As many emerging therapies for OA are injectable, it is imperative that we better understand patient and provider attitudes surrounding injectable therapies, as these factors could affect uptake,” they added. “Our group recently conducted a qualitative study to investigate patients’ beliefs and attitudes surrounding IA injection therapies and found that patients place substantial weight on providers’ guidance and recommendations for injectable therapies. Understanding providers’ perceptions of IA injection therapies is therefore essential to understanding treatment decisions.”
To analyze the risks and benefits of offering intra-articular injections for OA, as perceived by physicians, MacFarlane and colleagues conducted a series of interviews with 18 orthopedic surgeons, rheumatologists and physiatrists. Participants hailed from academic and community practices in Massachusetts and were recruited through a random sample of each professional organization’s online directory. All participating physicians reported frequently managing knee OA and prescribing intra-articular treatments.
The interviews were conducted over the phone by two investigators. Question topics included providers’ strategies for treating knee OA and their use of intra-articular injections, the administrative and financial impacts of injection use on their practice and the perceived benefits and risks of injection treatment in general and for specific injectables. All participants received a $100 check as compensation. The researchers used thematic analysis to identify factors that physicians consider when making recommendations for intra-articular injection.
According to the researchers, four themes influenced participants when making recommendations regarding injections. First, the physicians considered their own knowledge, beliefs and concerns, including their propensity to rely on guidelines as opposed to their clinical experience, as well as their understanding of the efficacy and risks associated with injectables, such as possible cartilage damage. Second, they considered the characteristics of the injectable drug, such as ease or number of administrations needed.
Third, they examined individual patient‐specific factors, including OA severity, comorbidities and patient preference for and expectations of specific injections. Lastly, they considered financial and administrative factors, including insurance coverage and out‐of‐pocket costs.
“These results may help inform the development of novel injectable agents as they provide insight into how medication efficacy, adverse effects and ease of administration factor into physician decision making,” MacFarlane and colleagues wrote. “From a clinical standpoint, the uncertain efficacy of IA injections and tension between guidelines and clinical experience highlight the desire for an agent that modifies OA or leads to more durable symptomatic relief. Future qualitative studies could examine how physicians would weigh specific trade-offs if a treatment was potentially disease-modifying.”
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