Biologic Treatment Preferences Revealed Among Psoriatic Arthritis Patients

Investigators found that when choosing biologic medications, patients with psoriatic arthritis preferred oral medications. Avoiding severe complications was also a top priority for patients. Next, patients wanted to maintain the ability to attend work and normal activities and avoid infection more than clinical measures of efficacy.

Daniel Sumpton, PhD, Sydney School of Public Health, University of Sydney, and a team of investigators conducted a discrete choice experiment (DCE) in patients with psoriatic arthritis from 3 rheumatology centers in Sydney, Australia. There were 150 participants that completed the study with a median age of 53.5 years.

Results and Motivation

Discrete choice experiments are often used with the intention of quantifying patient treatment preferences. The aim was to determine the most important factors for patients in real-life scenarios when making choices about their treatment.

The goal of the study was to assess patient preferences for the characteristics and outcomes of biologic and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) to manage psoriatic arthritis. The results showed a preference for an oral route compared with subcutaneous and intravenous routes.

Data showed the attributes in order of preference were, avoiding severe side effects, increasing ability to attend to normal activities, avoiding infections, improvement in enthesitis pain, improvement in psoriasis, increasing chance of remission, and improvement in joint pain.

The Latent Class Model

There were two groups of participants shown in the latent class model. The first group (LC-1) preferred avoiding serious complications, the ability to work or attend to normal activities, and improvement in joint pain. The second group (LC-2) prioritized characteristics related to the route and frequency of the medications.

This suggests that LC-1 patients who preferred avoiding serious complications of biologics but also value the ability to attend to work and social activities have less experience and knowledge of biologics and have earlier disease duration.

As opposed to LC-2 patients who were more experienced with biologic use and had higher perceived knowledge of their use and were more likely to be comfortable with the most frequently used subcutaneous methods of treatment.

For the route and frequency of medication, the patients in LC-2 preferred subcutaneous injections 1-2 times weekly while the patients in LC-1 preferred to avoid that attribute above all else.

In Conclusion

There’s consistency between these results and qualitative data suggesting that fear of severe side effects and short term side effects are significant factors for patients with psoriatic arthritis and spondyloarthropathy when choosing medications.

Overall, avoiding severe side effects or adverse events was the priority, followed by the ability to return to work and normal activities and avoiding severe infection. These were prioritized above clinical measures of disease improvement including improvement in joint pain, enthesitis or skin disease.

For the treatment of psoriatic arthritis, results showed that patients preferred oral treatments over subcutaneous or intravenous routes.

“There is a growing awareness of the importance of understanding the priorities of patients with psoriatic arthritis to improve their care,” investigators wrote. When selecting a biologic medication, there’s a need to understand the factors most important to patients and identify their main concerns and priorities.

The study, “Preferences for biologic treatment in patients with psoriatic arthritis: a discrete choice experiment” was published in Arthritis Care & Research.