Functional outomes favored by patients with PsA when choosing biologics
medwireNews: People with psoriatic arthritis (PsA) prioritize oral administration, avoiding severe complications, and maintaining the ability to attend work and resume normal activities over clinical measures of efficacy when it comes to medication preferences, research suggests.
“There is an apparent discrepancy between the outcomes of biologic medications most important to patients and the clinical parameters used by rheumatologists to inform measures of disease activity and treatment responsiveness,” say Daniel Sumpton (Concord Hospital, Sydney, New South Wales, Australia) and colleagues.
The team carried out a discrete choice experiment involving 150 patients (58.3% women, median age 53.5 years) with PsA treated at three rheumatology centers in Sydney, who were asked to consider the qualities of different treatments based on multiple choice sets of characteristics and outcomes, and choose the one they prefer.
Half of the participants were receiving a biologic at the time of the experiment, while 53.3% had prior experience with biologics (more than one biologic in 31.3% of patients).
The three most important preferences selected by the patients were oral administration, avoiding severe side effects, and the ability to attend work and normal activities, with corresponding beta coefficients of 1.00, 0.72, and 0.66.
These attributes were preferred above avoiding treatable infections, improving enthesitis pain, improving psoriasis, increasing the chance of remission, and improving joint pain, for which the beta coefficients were 0.38, 0.28, 0.28, 0.27, and 0.26, respectively.
To understand the heterogeneity of these preferences, the study investigators applied a latent class multinomial regression model and identified “two distinct groups of patients with different priorities when choosing biologic medications.”
The first group prioritized avoiding rare but serious complications, maintaining the ability to work or attend normal activities, and improve joint pain, with corresponding beta coefficients of 1.35, 1.19, and 0.82.
Patients in the second group placed greater importance on the route and frequency of medication, with a preference for subcutaneous injections 1–2 times a week, followed by oral tablets once or twice a day, and subcutaneous injection every 4 weeks, with beta coefficients of 1.97, 1.39, and 1.32, respectively.
The finding of two distinct groups indicates “the need to discuss the characteristics and outcomes of biologic treatments with individual patients,” the researchers emphasize.
The patients in the first group were more likely than those in the second group to be older than 53 years of age and female, and to have lower pain levels, no history of biologic use, a lower perceived knowledge of medications used for PsA, a higher household income, a shorter disease duration, and better skin scores.
Sumpton et al write in Arthritis Care & Research: “This study highlights the need for clinicians to focus on functional outcomes of treatment, adverse events and consider individual patient preferences when discussing biologic medications.”
They suggest “the need to develop decision aids to guide shared decision-making choices and focus discussion on factors important to patients when choosing biologic medications in psoriatic arthritis.”
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