RA patients place higher value on treatment benefits over attributes for DMARD therapy

Patients with rheumatoid arthritis (RA) who are being treated with disease-modifying antirheumatic drug (DMARD) therapy value treatment benefits more than treatment attributes, such as serious or minor side effects, cost, or route of administration, a study has shown.

A systematic review was performed to identify English-language studies of adult RA patients that measured patient preferences for DMARD or health states and treatment outcomes relevant to DMARD decisions. A published quality assessment toll was used to assess study quality. The investigators also summarized data on the importance of treatment attributes and associations with patient characteristics across studies.

A total of 7,951 abstracts were identified, including 36 studies from different countries. Most studies involved patients with established RA and were of medium (n=19) or high quality (n=12). Different methods were applied to draw preferences, with discrete choice experiment (DCE; n=13) being the most common.

Despite the heterogeneity of attributes in DCE studies, patients usually placed higher value on treatment benefits (disease improvement) over both nonserious (six of eight studies) and serious adverse events (five of eight studies), as well as administration route (seven of nine studies).

Among non-DCE studies, treatment benefits were deemed more important by patients, while others (in those with established RA) found that patients were quite “risk averse.” Moreover, patients often preferred subcutaneous over intravenous therapy.

“Patient preferences were variable and commonly associated with the sociodemographic characteristics,” the authors said. “The variability in patient preferences highlights the need to individualize treatment choices in RA.”