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Preferences of patients with rheumatoid arthritis regarding disease-modifying antirheumatic drugs: a discrete choice experiment

Authors van Heuckelum M, Mathijssen EGE, Vervloet M, Boonen A, Hebing RCF, Pasma A, Vonkeman HE, Wenink MH, van den Bemt BJF, van Dijk L

Received 11 February 2019

Accepted for publication 14 May 2019

Published 22 July 2019 Volume 2019:13 Pages 1199—1211


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Milou van Heuckelum,1,2 Elke GE Mathijssen,2 Marcia Vervloet,3 Annelies Boonen,4,5 Renske CF Hebing,6 Annelieke Pasma,7 Harald E Vonkeman,8,9 Mark H Wenink,2,10 Bart JF van den Bemt,1,11–12 Liset van Dijk3,13

1Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; 2Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands; 3Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; 4Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; 5Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; 6Department of Rheumatology, Reade, Amsterdam, the Netherlands; 7Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands; 8Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, the Netherlands; 9Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, Enschede, the Netherlands; 10Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands; 11Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands; 12Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands; 13Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, the Netherlands

Background: 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.

Keywords: rheumatoid arthritis, disease-modifying antirheumatic drugs, discrete choice experiment, treatment preferences

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