Background/Purpose: Several forums on the internet serve as repositories of personal experiences and exchange of health information. Online discussions among healthcare providers about management of patients with rheumatoid arthritis occur on a regular basis. Therefore, we explored and characterized the discussions about the use of triple therapy (methotrexate, sulfasalazine, hydroxychloroquine) on Internet forums, as differences in utilization among countries have been reported.

Methods: Online discussions were collected from three “leading edge” forums (ResearchGate, Medscape, and Twitter). Threads of discussion were systematically examined and interpreted to reveal recurring topics and patterns. Each post was coded and arranged into broader categories, which were combined into overarching themes.

Results: Twelve threads with 96 posts were identified. Seventy-nine of the posts were categorized. Seventeen were discarded because they were questions or comments unrelated to the topic discussed in the original thread. Four themes emerged during the analysis: (i) effectiveness (i.e., results from TEAR, Swefot and RACAT trials), (ii) costs, (iii) safety, and (iv) adherence. The first theme dealt primarily with the effectiveness of triple therapy compared with tumor necrosis factor inhibitors [discussion were around being as effective, but not in the first 12 weeks of treatment, or no improvement in radiographic progression]. The second theme focused on the costs. Although the majority agreed that it is a cost-saving alternative, especially in developing countries, some believed that biosimilars will be as cost-saving and more effective. Some were of the opinion that in the United States patients would have to pay 3 copays for the triple therapy regimen as opposed to 2 with a biologic option. The third theme involved a multitude of safety concerns, such as retinopathy, Stevens-Johnson syndrome, high liver enzymes or low blood cells, or the need for special monitoring in individuals with hepatitis C infection or nonalcoholic steatohepatitis. Tolerance was also a concern when sulphasalazine was not enteric-coated. Some suggested using other combinations such as adding fish oil or replacing sulphasalazine with leflunomide. The last theme covered the use of multiple drugs, which minimizes adherence.

Conclusion: The discussions in online forums showed extensive and cumulative discussions on attitudes and beliefs exchanged about triple therapy. Main concerns included radiographic progression, safety, and adherence which could partially explain low utilization of triple therapy in some countries.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prescriber-attitudes-and-beliefs-about-triple-therapy-for-patients-with-rheumatoid-arthritis-knowledge-exchange-in-internet-forums-and-social-media/