Pop a pill or give myself a shot? Patient perspectives of disease-modifying anti-rheumatic drug choice for rheumatoid arthritis.

Abstract

OBJECTIVE:

To assess how patients with rheumatoid arthritis (RA) decide whether to add oral disease-modifying anti-rheumatic drugs (DMARDs) versus injectable biologic DMARDs when methotrexate response is inadequate.

METHODS:

Using nominal group technique (NGT), RA patients answered the question "What sort of things are important to you when you make a decision between adding pills versus injectable medications to treat rheumatoid arthritis when methotrexate fails to control RA disease activity?" Patients nominated, discussed, and voted for the responses.

RESULTS:

Forty-seven RA patients participated: Birmingham (n=6 NG; 21 patients) and New York City (n=4 NG; 26 patients). They were predominantly female (85%), 70% white, with a mean age of 64.5 years and 58% had>10-year RA duration. Present/past DMARDs included methotrexate only in 6%, other traditional DMARDs in 15%, glucocorticoids in combination with traditional DMARDs in 11%, and biologics and/or Jak-kinase inhibitors in 68% of participants. Voted domains in order were: (1) efficacy/effectiveness and the onset/mode of action (78/282 votes); (2) side effects/fear of side effects (84/282 votes); (3) cost including out of pocket, co-payments and patient responsibility (54/282 votes); (4) convenience/frequency of use (27/282 votes); (5) doctor's opinion (20/282 votes); (6) other drugs/comorbidity/other patient's experience/effects on other people (3/282 votes); (7) fear of needles (8/282 votes); and (8) newness of the medication (8/282 votes).

CONCLUSIONS:

We identified the patient perspective regarding the choice between adding oral versus injectable DMARD once methotrexate failed to control RA disease activity. This knowledge can help in shared decision-making for DMARD choice in RA treatment.

• Authors: Jasvinder A Singh, Haley Tornberg, Susan M Goodman
• Journal: Joint bone spine (Joint Bone Spine) Vol. 88 Issue 1 Pg. 105053 (01 2021) ISSN: 1778-7254 [Electronic] France
• PMID: 32681975 (Publication Type: Journal Article)
• Copyright: Published by Elsevier Masson SAS.

Chemical References

• Antirheumatic Agents
• Biological Products
• Methotrexate

Topics

• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Biological Products (therapeutic use)
• Drug Therapy, Combination
• Female
• Humans
• Methotrexate (therapeutic use)
• Middle Aged