Preferences of patients with rheumatoid arthritis regarding disease-modifying antirheumatic drugs: a discrete choice experiment
2019
textabstractBackground: Although patients have different treatment preferences, these individual
preferences could often be grouped in subgroups with shared preferences. Knowledge of
these subgroups as well as factors associated with subgroup membership supports health care
professionals in the understanding of what matters to patients in clinical decision-making.
Objectives: To identify subgroups of patients with rheumatoid arthritis (RA) based on their
shared preferences toward disease-modifying antirheumatic drugs (DMARDs), and to identify factors associated with subgroup membership.
Methods: A discrete choice experiment to determine DMARD preferences of adult patients
with RA was designed based on a literature review, expert recommendations, and focus groups.
In this multicenter study, patients were asked to state their preferred choice between two different
hypothetical treatment options, described by seven DMARD characteristics with three levels
within each characteristic. Latent class analyses and multinomial logistic regressions were used
to identify subgroups and the characteristics (patient characteristics, disease-related variables,
and beliefs about medicines) associated with subgroup membership.
Results: Among 325 participating patients with RA, three subgroups were identified: an
administration-driven subgroup (45.6%), a benefit-driven subgroup (29.7%), and a balanced
subgroup (24.7%). Patients who were currently using biologic DMARDs were significantly
more likely to belong to the balanced subgroup than the administration-driven subgroup (relative
risk ratio (RRR): 0.50, 95% CI: 0.28–0.89). Highly educated patients were significantly more
likely to belong to the benefit-driven subgroup than the balanced subgroup (RRR: 11.4, 95% CI:
0.97–133.6). Patients’ medication-related concerns did not contribute significantly to subgroup
membership, whereas a near-significant association was found between patients’ beliefs about
medication necessity and their membership of the benefit-driven subgroup (RRR: 1.12, 95% CI:
1.00–1.23).
Conclusion: Three subgroups with shared preferences were identified. Only biologic
DMARD use and educational level were associated with subgroup membership.
Integrating patient’s medication preferences in pharmacotherapy decisions may improve
the quality of decisions and possibly medication adherence.
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