Patients, physicians share decision-making when choosing RA therapy
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Most patients with rheumatoid arthritis were involved in conversations about treatment decisions with their rheumatologist, according results of a multinational European survey presented at ACR Convergence 2021.
“The overall findings emphasize the importance of shared decision-making and taking into account factors related to patient preference and acceptability,” Peter C. Taylor, PhD, FRCP, MA, of University of Oxford, told Healio. “In recent years the therapeutic armamentarium for treatment of rheumatoid arthritis has greatly expanded. But with increasing therapeutic options comes the challenge of the most appropriate treatment choice, especially given that, as yet, we have no truly precision medicine biomarkers that reliably inform management decisions for individual people living with rheumatoid arthritis. Therefore, this research was undertaken to better understand the drivers of therapeutic choice for physicians, and recognizing the importance of the patient viewpoint in this process, to understand the extent to which shared decision-making was employed.”
Using data from the Adelphi RA Disease Specific Programme, Taylor and colleagues surveyed rheumatologists and their patients with RA in Belgium, France, Germany, Spain, Italy and the U.K.
A total of 316 rheumatologists collected demographic, clinical and treatment data for 3,121 patients with RA and noted the reasons for their current treatment modality. Of those patients, 1,130 answered a questionnaire reporting treatment satisfaction on a 5-point scale and perceptions of shared decision-making.
Patients with moderate to high disease activity comprised 23% of patient respondents. Either a biologic or a targeted synthetic disease-modifying antirheumatic drug, defined as advanced therapy, was used to treat 69% of patients, with first-line advanced therapy used in 72%, according to the presentation.
Of patients not taking an advanced therapy, 15% had a clinical condition indicating a need for an advanced therapy.
“We were surprised to find that a significant minority of patients who might benefit from an advanced therapy and met eligibility criteria were not receiving one,” Taylor told Healio. “We were able to explore some of the reasons for this, both from the perspective of prescribing physician and the patient.”
Top reasons for opting to not take advanced therapy were patient concerns about infection (24%), tolerability and safety of conventional synthetic DMARDs (18%) and patient dislike of infusions or injections (17%).
Of the physician and patient respondents, 855 reported having a conversation about treatment decision, resulting in a 79% net alignment, and 814 reported it was a shared decision (75% net alignment).
Among 2,143 patients on advanced therapy, 19% were prescribed janus kinase (JAK) inhibitors, 57% of whom were prescribed JAK inhibitors as monotherapy and 43% as combination therapy. Physicians reported JAK inhibitors were chosen due to perceptions of efficacy overall and as a monotherapy, fast onset of action and ability to inhibit disease progression. Patient-related factors of acceptability, including delivery method and ease of use, were also considered, according to the presentation.
In 135 patient-physician pairs, 62% of physicians and patients were equally satisfied with JAK inhibitor treatment, while 30% of patients were less satisfied than their physician.
“Further research in this area might be to investigate best approaches to shared decision making and tools to facilitate this process in the face of an ever-increasing complexity of therapeutic choice,” Taylor said.
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Taylor PC. Abstract 0824. Presented at: ACR Convergence 2021; November 3-10, 2021 (virtual meeting).
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