Background/Purpose: Little is known about how patient and physician expectations relate to clinical outcomes. This study investigated the expectations that patients and physicians have at the start and after 3 months of treatment with golimumab (GLM) for RA and evaluated the relationship between these expectations and treatment outcomes.

Methods: GO-MORE was an open-label, multinational, prospective study in biologic-naïve patients who had active RA despite DMARD treatment. All patients received 50-mg subcutaneous GLM once monthly for 6 months. At baseline and after 3 months of treatment, patients rated their overall expectation of how well their treatment would control RA symptoms. They also rated the ability of the treatment to relieve specific symptoms and improve quality of life 3 months later using 5-point Likert scales (1=good outcome, 5=poor outcome). Patients were then divided into tertiles of expectation scores: high (≤1.5), medium (>1.5 to <1.86), or low (≥1.86). Patients indicated which attribute they wanted to improve most. Physicians were asked to predict patient disease state 3 months later and selected (from the same list used by patients), the attribute they thought patients most wanted to improve.

Results: At baseline, 3280 patients had mean age of 52.3 (SD=12.8) years, median disease duration of 4.9 years, mean HAQ-DI of 1.44 (SD=0.67) and had moderate (21.3%) or high disease activity (78.7%). Prior to starting treatment, 95.9% of patients expected GLM to be better than their current DMARD treatment. After 3 months of treatment, 85.1% expected the treatment to be more effective still by month 6. The attributes patients wanted to improve most were pain and quality of life, with pain selected by most patients at baseline and quality of life selected by most following 3 months of treatment. Patients with more positive expectations about treatment had greater improvement in DAS28-ESR and HAQ scores and were more likely to show good EULAR response at month 6 than patients with less positive expectations (Table 1).

Table 1. Relationship Between Patients’ Baseline Treatment Expectations and Improvement in Outcomes

^aP values are for pairwise comparison with high expectation group.

^bP values >0.001 are considered to be nonsignificant.

At baseline, physicians expected 29.6% of patients to attain remission and 59.2% to attain low disease activity after 3 months of treatment. At the end of month 3, they expected 38.8% to attain remission and 53.1% to attain low disease activity by the end of month 6. Physicians identified pain and tender and swollen joints as the issues they thought their patients most wanted to improve.

Conclusion: Despite similar baseline scores, patients with more positive expectations about outcomes of GLM treatment demonstrated better outcomes than patients with less positive expectations.