Background/Purpose: Current guidelines for the treatment of rheumatoid arthritis (RA) recommend that patients who are not adequately responding to treatment with disease modifying anti-rheumatic drugs (DMARDs), most often methotrexate, initiate treatment with biologic therapy.  However, from the patient perspective, there may be many other factors which influence this decision.  This study describes the experience of patients who are considering biologic therapy to manage their RA.

Methods: :  Study patients were recruited through two sources: the patient advocacy organization, CreakyJoints, and the Lightspeed Research consumer panel.  Patients were U.S. adults (aged ≥18), diagnosed with RA, and currently treated by a rheumatologist with DMARDs.  Patients had no history of biologic use but had discussed biologic therapy with their physician.  Data were collected directly from patients through a self-administered, web-based questionnaire. 

Results: Among the 243 patients who completed the study, the mean (SD) time that elapsed since discussions about biologic therapy began was 1.3 (1.8) years over a mean (SD) of 2.7 (2.6) office visits.  Rheumatologists were most likely to initiate the discussion (54%), but 23% of patients reported initiating it.  A majority of patients (>73%) reported discussing the following aspects of biologic therapy  either somewhat or in detail: ability to improve well-being or daily functioning; ability to improve mobility or range of motion; ability to slow or stop joint damage; potential side effects; how treatment is taken/administered; and frequency of administration.  However, fewer than 39% of patients reported discussing the subcutaneous injection experience, the intravenous infusion experience, or financial and treatment support programs.  Most patients believe they are the primary decision maker: 25% make the final decision about treatment and 49% make the final decision after considering their rheumatologist’s recommendation.  When making treatment decisions, 74% of patients reported that they consider both their current and future situations, though 15% only consider the present and 10% only consider the future.

Conclusion: Patients with RA are active participants in the process of initiating biologic therapy.  Rheumatologists should actively engage their patients in the shared-decision making process for initiating biologic therapy.  As demonstrated by previous research, effective communication between patients and providers may have a positive impact on patient satisfaction and adherence to therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/initiation-of-biologic-therapy-the-patient-perspective/