ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 429

Treatment Preferences of Patients with Early Rheumatoid Arthritis: A Discrete-Choice Experiment

Glen S. Hazlewood1,2, Claire Bombardier3, George A. Tomlinson4, Carter Thorne5, VP Bykerk6, Andrew Thompson7, Diane Tin8 and Deborah Marshall9, 1Medicine, University of Calgary, Calgary, AB, Canada, 2Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, 3Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada, 4Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, 5Southlake Regional Health Centre, Newmarket, ON, Canada, 6Rheumatology, Hospital for Special Surgery, New York, NY, 7Rheumatology, St Joseph's Hlth Ctr, London, ON, Canada, 8The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 9University of Calgary, Calgary, AB, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: , ,

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Treatment choices in early rheumatoid arthritis need to balance benefits, risks, and other considerations such as dosing and monitoring. The objective of this study was to determine the preferences of patients with early rheumatoid arthritis (RA) for these competing issues.

Methods: We assessed patients’ preferences using a discrete-choice experiment. Consecutive adult patients with early RA (<2 years since diagnosis) in 2 Canadian centres were presented 13 different sets of three treatment options described by 8 attributes (clinical trial outcomes, risks, monitoring and dosing regimens) and asked to choose one.  We estimated the value that patients placed on each attribute level using a main-effects multinomial logit model, and explored preference heterogeneity through latent-class analysis.

Results: 152 patients completed the survey (86% response rate): mean age 52, 63% female, disease duration 7.8 months. Fourteen (9%) were DMARD naïve, and 44% had changed DMARD treatment within 3 months. Treatment benefits (increasing the chance of a major symptom improvement (ACR50 response) and reducing the chance of serious joint damage) were most important. Of potential adverse events, a ‘small risk of serious infections/possible increased risk of cancer’ was the most important. Patients were willing to accept this risk for an increase of 15% in the chance of a major symptom improvement (Table 1). Patients had an aversion to intravenous therapy, but were relatively indifferent to other dosing regimens. Alcohol restriction and the need to have regular eye exams to screen for eye toxicity were unimportant. Through latent-class analysis, we identified two patient groups – 46% who were highly benefit-driven, and others who were more risk averse, particularly to the possible risk of cancer/infection (Table 1).

Conclusion: Patients with early RA were generally risk-tolerant and preferred oral and subcutaneous based treatments that provided the greatest chance of benefit, but clinicians need to be aware of important preference differences and tailor treatment approaches appropriately.

Table 1: Relative importance of undesirable treatment characteristics

Treatment characteristic

Absolute increase in probability of major symptom improvement (ACR50 response) required to accept characteristic

Overall analysis (all patients)

Latent class analysis

Benefit-driven subgroup

(46% of patients)

Risk-averse subgroup

(54% of patients)

Trial outcomes

 

 

 

Chance of serious joint damage increased from 2% to 30%

31% (26 to 35)

27% (23 to 32)

47% (34 to 65)

Chance of stopping due to a side effect increased from 2% to 20%

9.5% (6.3 to 13)

6.8% (4.1 to 9.6)

18% (8.7 to 30)

Rare risks and monitoring

 

 

 

Possible increased risk of cancer and small risk of serious infection

15% (13 to 18)

3.6% (2.1 to 5.2)

48% (38 to 64)

Rare risk of lung/liver reaction (need regular bloodwork)

7.6% (5.6 to 9.7)

2.2% (0.60 to 3.8)

25% (18 to 35)

Need to restrict alcohol

3.1% (1.2 to 5.0)

0.95% (-0.58 to 2.5)

9.9% (4.3 to 17)

Need regular eye exams (to watch for build up in back of eye)

1.3% (-0.59 to 3.2)

0.68% (-0.88 to 2.2)

3.8% (-1.6 to 9.7)

Dosing regime

 

 

 

Weekly injections instead of weekly pills

0.39% (-4.5 to 5.4)

-1.6% (-5.5 to 2.4)

9.6% (-4.2 to 25)

3 meds (weekly + 6 daily pills) instead of weekly pills

2.8% (-2.3 to 8.0)

-1.2% (-5.4 to 2.9)

17% (2.6 to 34)

IV infusions every 8 weeks instead of injections every 2 weeks

14% (9.2 to 20)

8.4% (4.3 to 13)

26% (11 to 45)

Disclosure: G. S. Hazlewood, None; C. Bombardier, None; G. A. Tomlinson, None; C. Thorne, Anzares, Medac, 5; V. Bykerk, None; A. Thompson, None; D. Tin, None; D. Marshall, None.

To cite this abstract in AMA style:

Hazlewood GS, Bombardier C, Tomlinson GA, Thorne C, Bykerk V, Thompson A, Tin D, Marshall D. Treatment Preferences of Patients with Early Rheumatoid Arthritis: A Discrete-Choice Experiment [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/treatment-preferences-of-patients-with-early-rheumatoid-arthritis-a-discrete-choice-experiment/. Accessed .

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