Background/Purpose: Treatment choices in rheumatoid arthritis (RA) involve trade-offs in risks, benefits and other considerations such as dosing. Understanding patient preferences for these trade-offs is critical for making patient-centred treatment recommendations. The objective of this study was to summarize patients’ preferences for disease modifying anti-rheumatic drug (DMARD) therapy in RA.

Methods: A systematic review was conducted to identify English-language studies in adult RA patients that measured patients’ preferences for DMARDs or health states and treatment outcomes relevant to DMARD decisions. We included any study that provided a quantitative assessment of patient preferences, which was defined according to the MeSH definition in the National Library of Medicine as an “individual’s expression of desirability or value of one course of action, outcome, or selection in contrast to others”. Study quality was assessed using a published quality assessment tool. Data on the importance of treatment attributes and associations with patient characteristics was summarized across studies.

Results: From 7951 abstracts, we included 36 studies, from a variety of countries. Most studies were in patients with established RA and were rated as medium (n=19) or high quality (n=12). The methods to elicit preferences varied, with the most common being discrete choice experiment (DCE) (n=13). Twenty two were focused on decision-making between advanced therapeutics. Despite heterogeneity of attributes in DCE studies, collectively, treatment benefits were usually more important than both serious and non-serious adverse events. Dosing and administration attributes were typically less important than benefits while route and frequency were more important than adverse events. Risk tolerance varied considerably and 3 out of 5 studies showed patients preferred subcutaneous over intravenous therapy. Patient preferences were more commonly associated with sociodemographic variables rather than RA disease characteristics.

Conclusion: Overall, the results support current RA intensive ‘treat-to-target’ treatment paradigms, but the variability in preferences highlights the need to individualize treatment choices in a shared decision-making context.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-preferences-for-disease-modifying-anti-rheumatic-drug-treatment-in-rheumatoid-arthritis-a-systematic-review/