Background/Purpose: Increasingly, evidence suggests that treatment of people at risk of rheumatoid arthritis (RA) with anti-rheumatic drugs could prevent the onset of disease. Ongoing randomized controlled trials of treatments to prevent RA are starting to report their findings. There will be uncertainty about preventative treatment in practice, arising from the ability to predict who is at risk of RA, uncertain benefits and risks with preventative treatment and the convenience of treatment to the recipient. The aim of this study was to determine the preferences of pre-symptomatic, at risk people, for preventative treatment and the likely uptake of preventative treatment

Methods: A discrete choice experiment was administered using a web survey to North American patients and first-degree relatives of patients, asking participants to first choose between sets of 2 hypothetical preventative RA treatments, then choose between their preferred treatment and ‘no treatment for now’. Focus groups of RA patients, first-degree relatives of RA patients and rheumatologists identified 5 key attributes of treatment (reduction in risk of RA, how treatment is taken, chance of side effects, certainty in estimates, health care providers opinion). An experimental design using SAS developed 18 choice sets blocked into 4 sets of 11 choices, which included 2 consistency checks. DCE data was analyzed using a conditional logit regression model to estimate the significance and relative importance of attributes in influencing preferences.

Results: 597 people (25% of whom reported having RA) started and completed all tasks in the survey. The majority of the sample were from the USA (88%), aged between 25 and 64 years, modal age category was 30 to 39 years (52%), and 59% female. All attributes levels significantly influenced preferences for treatments, but how treatment is taken (oral vs. infusion β0.971, p<0.001) was the most influential, followed in similar magnitude by reducing risk of side effects (β0.862, p<0.001), matching of patient and health care professional preferences (β0.859, p<0.001), and increasing risk reduction (β0.839, p<0.001). The strength of preference for reducing uncertainty in evidence was statistically significant but smaller in magnitude (moderate from very little certainty β0.487, P=0.005). Respondents would be most willing to trade a reduction in risk of RA for an oral route of administration followed by a treatment preferred by their health care professional. The preferred preventative treatment was chosen over no treatment in 67% of choices.

Conclusion: Our survey suggests that the most important feature of preventative strategy for RA will be the convenience of taking treatment, followed by the potential risks and benefits of treatments, but equally the recommendation or preference of their health care provider. The degree of confidence in estimates of risks and benefits of treatments is also important in people’s decisions to accept treatment. The uptake of a preventative strategy will depend on these key factors. This evidence will help policy makers understand whether different preventative treatment strategies are likely to be acceptable to people to whom they might be offered.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/preventing-rheumatoid-arthritis-north-american-perspectives-of-patients-and-first-degree-relatives-on-the-risk-of-developing-the-disease-and-of-potential-preventative-interventions/