Alexis Ogdie, MD: Importance of Patient Experience in Psoriatic Arthritis Treatment

Rheumatology Network spoke with Alexis Ogdie, MD, to discuss her study, “Real-World Patient Experience and Treatment Preferences in Patients With Psoriatic Arthritis,” which was recently presented at the EULAR 2021 Virtual Congress. Ogdie is a medical advisor for CreakyJoints, as well as Associate Professor of Medicine and Epidemiology and rheumatologist at the University of Pennsylvania. She explains the importance of understanding the patient perspective, the survey they employed to evaluate symptoms and disease impact, and the ultimate results of the study.

Rheumatology Network: To begin, why is it important for rheumatologists to understand a patient's experience of living with psoriatic arthritis and their treatment preferences?

Alexis Ogdie, MD: Well, 1 of the things is, as a rheumatologist, we're often focused on the number of joints that are swollen, whether or not there's dactylitis, or axial disease. So, thinking very much about the physical aspects of the disease. And what I think some of the studies about preferences show us is that it's more about the impact than the number of swollen joints, for example. And so that kind of helps us come up with a well-rounded treatment plan if we've thought through all the potential ways in which the patient is being impacted by the disease.

RN: Why do patients with psoriatic arthritis frequently experience inadequate or intolerance to therapies?

AO: So, first of all, I don't know that they always frequently have intolerance, I think, actually, most therapies are pretty well tolerated. In particular, our biologic therapies, for example, are very well tolerated medications overall. Now, unfortunately, there is in inadequate response to many of our therapies, so we still at best get about 30 to 40% of our patients to remission with an individual therapy. And that's kind of at best, like I said, so we have a long way to go into getting better therapies that really treat the patient to a level of disease activity that they want. I think the main thing is people end up switching therapies because 1 isn't really good enough. And sometimes you have to go through a couple to find the one that's right for that particular patient.

RN: Can you tell me a little bit about the methods you and your team use to create the study design and survey?

AO: ArthritisPower is a patient-powered research network, so patients can go on and contribute their data. And so, we utilized that network to deliver a survey to patients with psoriatic arthritis, and they responded about their treatment preferences. Before we sent the survey, we asked some individual patients about their experiences to help us come up with a list of different items to include on the survey so that we were covering the full range when we sent the items out to the patients.

RN: And what were some of the symptoms and disease impacts that the study evaluated?

AO: It evaluated the importance of a variety of physical features like joints, dactylitis, enthesitis, psoriasis, and then it also evaluated the relative importance to patients of the individual impact. So, whether that be fatigue, diminished physical activity, and being able to socialize. Those kinds of things. So, we asked patients to rank among those.

RN: And what were the results of the study?

AO: We found that patients in this particular study had mainly mild psoriasis. And so they've actually rated the psoriasis as not as important to them. And I think that would be different if you had a group of patients who had more moderate to severe psoriasis. They may right rate that more highly. We also found some of the same impacts that we've seen in other studies that pain is important to patients, but physical function and fatigue are also important symptoms for patients who are managing this disease.

RN: Are you surprised by the results?

AO: No, we actually weren't surprised by the results. We've seen this with other studies as well. But this was nice confirmatory test to make sure that this other population of patients is feeling the same way as previous study patients as well.

RN: What do you believe patients preferred omitting methotrexate from their treatment plan?

AO: Patients often report to us that they have nausea or fatigue after methotrexate. In rheumatoid arthritis we hear the same thing, but in rheumatoid arthritis, it also works pretty well. And so, patients will take that tradeoff for having improved disease activity. On the other hand, in psoriatic arthritis, there may not be the same level of efficacy. And so, in some patients who aren't doing better, the tradeoff for the risk benefit ratio isn't worth it to them; they get these side effects without significant improvement. So, I think that's 1 of the reasons that patients were in favor in general of dropping methotrexate. Additionally, many of these patients had been through that drug already. If you ask the individual patient sitting in front of you on methotrexate, they may or may not feel that way. But most of these patients had already been through methotrexate.

RN: Why do you believe patients prefer oral medications once a day and injection once a month over other treatment methods?

AO: Well, in this particular study, patients were interested in being able to travel and not having to worry about bringing their injectable medication with them. And so that was 1 of the reasons they preferred oral. And I'd say on average, patients in this particular study preferred oral over subcutaneous, but, you know, it varies by patient for their individual lifestyle. So, a once daily medication is generally pretty easy to take and monthly injections are easy to take as well. Some of my patients even prefer the weekly injections simply because then they remember it too. I think it's just varied by patient population, but on average patients prefer the once daily oral drug.

RN: Why is the mode of administration an important factor in starting a new therapy?

AO: Well, I think it comes back to patient's lifestyle. So, you have to really assess: what are they doing on a day-to-day basis? Are they traveling much? What are their needs? And how are they going to best remember the medication? So, each patient has something that might be unique for them.

RN: Was the study strengthened or limited by any factors that you'd like to discuss?

AO: The patient population was a group of, in general, educated patients who had mild psoriasis. So, I think we just have to kind of take that with a grain of salt. Many of these people are in the patient-powered research network because they're very interested and kind of active patients. So that would just be 1 consideration that we always think about when we're talking about a survey to a specific patient population.

RN: Does your team plan on doing any further research on the topic?

AO: We've done a few other studies. My own group has also looked at patient preferences in a similar but slightly different way, and basically found very similar things as well. One of the things we've thought about is: can we better identify treatment paradigms or ways of thinking about treatment that directs to what the patient wants? And if we had a standardized way of assessing patient preferences, and then a standardized way of kind of helping formulate a treatment plan that takes into account all the impacts that the patient is experiencing, that might be helpful to the clinician when you're kind of coming up with a treatment plan in a relatively short visit.

RN: Is there anything else you'd like our audience to know about ArthritisPower, CreakyJoints, or psoriatic arthritis?

AO: One thing is CreakyJoints is a great reference for your patients. I give that to my patients all the time. It's nice because it's reviewed by physicians. So, there's some good content there. There are also patient guideline booklets that have a lot of detailed information for the patient who wants a lot of detailed information. And then ArthritisPower is great because there's an app and they can track their outcome measures. So, if you have that patient that's really interested in improving their fatigue, or you want to do an intervention or something, they can track their own symptoms on that app and then show you their symptoms. I find it not only a good way to contribute to the research community, but actually its a very practical way of tracking outcome measures. That's something that I recommended to my patients.

RN: Well, thank you so much for speaking with me today. I really appreciate it.

AO: Thank you so much.