Patients with psoriatic arthritis prioritize work, 'normal activities' over clinical efficacy
Patients with psoriatic arthritis prefer oral over subcutaneous biologics, and prioritize complication avoidance and the ability to work and perform ordinary activities over clinical efficacy, according to data.
“There is a growing awareness of the importance of understanding the priorities of patients with psoriatic arthritis to improve their care,” Daniel Sumpton, PhD, of the University of Sydney and Concord Hospital, in Australia, and colleagues wrote in Arthritis Care & Research. “Guidelines on the treatment of psoriatic arthritis also stress the need for shared decision-making.”
“There is a need to understand the factors most important to patients when selecting a biologic medication, to identify the patient's main concerns and priorities, enhance patient engagement in care, and improve treatment adherence and outcomes that are important to patients,” they added. “Biologic medications are also costly to patients, governments or insurers and it is important to understand the values that patients place on the qualities of medications to inform the design and approval of medications that patients are willing to accept.”
To examine patient preferences regarding outcomes and treatments in managing PsA, Sumpton and colleagues conducted a discrete choice experiment at three rheumatology centers in Sydney. Participants included adults with PsA currently receiving biologic, targeted synthetic or conventional disease-modifying antirheumatic drugs. Through a survey, the researchers assessed participants’ preferences for certain biologic treatments, with the patients describing route and frequency using a range of five levels.
Similarly, the ability to perform normal activities, joint pain improvement, enthesitis and skin disease, the chance of remission, infection risk and the risk for severe adverse events were described based on a range of three levels. The researchers used multinomial logit models, including a latent class model, to analyze patient preferences.
In all, 164 participants responded to the survey, out of a total of 199 invitations. Among these participants, 150 completed the survey and were included in the analysis.
According to the researchers, the most important factors to patients, in order of preference, were oral medication rather than subcutaneous or intravenous routes ( coefficient = 1; fixed-parameter), avoiding severe side effects ( coefficient = 0.72; 95% CI, 0.5-0.95), improved ability to perform normal activities (0.66; 95% CI, 0.36-0.96), avoiding infections (0.38; 95% CI, 0.23-0.53), improved enthesitis pain (0.28; 95% CI, 0.2-0.36), improved psoriasis (0.28; 95% CI, 0.2-0.36), chance of remission (0.27; 95% CI, 0.19-0.36) and improved joint pain (0.26; 95% CI, 0-0.52).
“When choosing biologic medications, patients with psoriatic arthritis preferred avoiding serious adverse events, the ability to work or attend to normal activities and the risk of infection over measures of efficacy, including the chance of disease remission and improvements in joint pain, enthesitis and psoriasis,” Sumpton and colleagues wrote.
“Overall, patients prioritized oral medications over subcutaneous medications and intravenous infusions,” they added. “There were differences in the preferences for biologic characteristics and outcomes based on clinical and participant characteristics. This study highlights the need for clinicians to focus on functional outcomes of treatment, adverse events and consider individual patient preferences when discussing biologic medications.”