Background/Purpose:

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease characterized by diverse clinical manifestations, chronic inflammation, and significant morbidity that can be fatal¹. Treatment strategies for SLE focus on managing symptoms, reducing flares, preventing organ damage, and improving health-related quality of life^2,3. Specific treatment goals should reflect shared decision making between the physician and patient. Currently, patients and physicians have a choice regarding mode of administration for SLE treatments, which range from oral medications, intravenous infusions (IV) and subcutaneous injections (SC). Given these choices, it is important to understand patient and physician characteristics that may drive the choice of selecting a mode of administration. The primary objective of the study was to examine patient and physician characteristics that are associated with the choice of IV or SC for an unspecified SLE treatment.

Methods:

An online exploratory stated preference study was conducted with patients and physicians recruited from a web panel in the U.S. among 200 SLE patients and 200 rheumatologists who treat SLE. The survey development was informed by the results of qualitative interviews with physicians who treat SLE and the final surveys were pretested with SLE patients and physicians who treat SLE. The direct elicitation questions described hypothetical SLE treatments with different modes of administration. Pairwise and multivariate analyses were used to estimate the odds ratio (OR) for the likelihood of choosing SC over IV for a variety of respondent characteristics.

Results: Among the respondents, the mean (SD) age was 50.4 (14.0) in patients with SLE (86% female) and 51.4 (10.9) in rheumatologists who treat SLE (>50% in practice for >10 years). Analyses from the patient survey indicated that older respondents were more likely to select SC (OR=4.2); respondents with a fear of needles or self-injection (OR=0.1) and those who never need assistance with household activities (an indicator of higher quality of life) were less likely to choose SC (OR=0.1). Analyses from the physician survey suggested that 15 years or fewer years of training (OR=1.4) and a general preference for SC or IV (OR=2.1) are associated with physician’s choice of SC over IV. Treating 21-40 SLE patients each week rather than more (OR=0.6), having two-thirds of treated SLE patients with mild disease rather than more (OR=0.6), having more than 8 infusion chairs in clinic (OR=0.6), and spending more than 80% of the time (OR=0.7) in direct patient care are associated with physician’s choice of IV over SC.

Conclusion:

This exploratory study is among the first preference studies conducted with SLE patients and physicians who treat SLE. Patient’s age, severity of the disease, as well as a range of physician characteristics may play a role in choosing one route of administration over another. These insights may inform shared decision making, which may lead to better alignment between treatment choice and patient preferences, treatment satisfaction, adherence, and improved patient outcomes. The results of this study may inform the development of hypotheses for future studies. (Study funded by GSK HO-16-16706)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/physician-and-patient-preferences-for-treating-sle-insights-into-the-choice-of-intravenous-infusion-and-subcutaneous-injection/