Background/Purpose: Due to the increasing tendency of involving patients in decisions regarding their health care and knowing the need for further research on patients’ preferences about treatment and adherence, the aim of this study was to evaluate the treatment preferences of patients with Axial Spondyloarthritis (axSpA) and to identify the factors associated with their choice.

Methods: Patients diagnosed with axSpA (ASAS 2009 criteria) were included. Sociodemographic data, disease characteristics, disease activity and treatments received were recorded. A specially designed questionnaire was administered to evaluate patient preference for the drug administration, doses frequency, the favorite site and the person chosen for the drug administration. Also the attributes and disadvantages of the chosen rout were assessed, as well as the characteristics and compliance with the current treatment. Statistical analysis: Student’s T-test, Chi2 test and multiple logistic regression analysis.

Results: Seventy patients were included with a median age (m) of 46.5 years (IQR 38-57), 55 males (78.6%) and a median disease duration of 13.5 years (7.75-23.25).
According to the patients, the relevant aspects in decreasing order of frequency for choosing a treatment were: the ability to improve quality of life (32.9%), improvement in joint inflammation (22.9%), pain (21.4%) and physical function (14.3%). Sixty-three patients (90%) chose to receive the medication at home, and 55 (78.6%) chose to self-administrate the drug. The most chosen mode of administration was oral (51.4%), following by subcutaneous (SC) (41.4%), intramuscular (IM) 4.3% and intravenous (IV) 2.9%. The preferred frequency of oral administration was one tablet per week (61.1%) and SC administration, once a month (34.5%). The main advantages of oral administration were: the easy administration (58.3%), no need for a special skill (33.3%) and no requirement of refrigeration (16.7%), and in the case of SC: the easy application (44.8%), the efficacy (27.6%) and the safety (13.8%). The choice of oral route was associated with: preference for self-administration (88.9% vs 11.2%, p = 0.05), preference for receiving the medication at home (97.2% vs 2.8%, p = 0.02) and higher level of education (14.5 ± 4.2 years vs 11.5 ± 4.7 years, p = 0.009). These last two variables remained significant in the multivariate analysis.
The choice of the SC route was independently associated with the type of axSpA (46.7% in ankylosing spondylitis (AS) vs 10% in non-radiographic axSpA (nr), p = 0.038).
The patients with greater adherence to treatment were receiving more frequent biological SC treatment (52.7% vs. 13.3%, p = 0.008), and had lower disease activity, higher functional capacity and better quality of life. In the multiple logistic regression model, being receiving biological SC treatment and having lower disease activity remained significantly associated with the treatment compliance according to the patient.

Conclusion: The most preferred way of administration by patients with axSpA was the oral route, with a weekly frequency and self-administration at home, followed by the subcutaneous route, with monthly infusion.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-preferences-in-patients-with-axial-spondyloarthritis/