Glen S Hazlewood1, Claire Bombardier2, George Tomlinson3, Deborah Marshall4. 1. Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta T2N4Z6, Canada. Electronic address: glenhazlewood@gmail.com. 2. Department of Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto M5G2C4, Canada; Toronto General Research Institute, University Health Network, Toronto M6J3S3, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto M5T3L9, Canada. 3. Department of Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto M5T3M6, Canada. 4. Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta T2N4Z6, Canada; McCaig Institute for Bone and Joint Health, University of Calgary T2N4Z6, Calgary, Canada.
Abstract
OBJECTIVES: The objective of the study was to estimate the preferred treatment for early rheumatoid arthritis using a novel Bayesian approach that jointly considers patients' preferences and comparative effectiveness research. STUDY DESIGN AND SETTING: We estimated the preferred treatment using patients' preferences measured in a discrete-choice experiment to apply weights to benefit and harm outcomes from a network meta-analysis and other considerations (dosing, rare adverse events). Using Bayesian analyses, we considered the variability in patients' preferences and the imprecision in both patients' preferences and the treatment effects; all key considerations in the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: We estimated that most patients in our population would prefer triple therapy as initial treatment (78%) or after an inadequate response to methotrexate (62%). The probability of choosing triple therapy as initial treatment was further from 50% (the point of indifference) for more patients, making our prediction more confident, and suggesting a stronger recommendation could be made. After an inadequate response to methotrexate, the choice was more split, suggesting a decision aid may be helpful. CONCLUSION: Using a novel approach, we estimated that many patients with early rheumatoid arthritis may prefer triple therapy to other treatment options, in contrast to existing guidelines. This offers an approach that may help inform Grading of Recommendations Assessment, Development, and Evaluation treatment recommendations.
OBJECTIVES: The objective of the study was to estimate the preferred treatment for early rheumatoid arthritis using a novel Bayesian approach that jointly considers patients' preferences and comparative effectiveness research. STUDY DESIGN AND SETTING: We estimated the preferred treatment using patients' preferences measured in a discrete-choice experiment to apply weights to benefit and harm outcomes from a network meta-analysis and other considerations (dosing, rare adverse events). Using Bayesian analyses, we considered the variability in patients' preferences and the imprecision in both patients' preferences and the treatment effects; all key considerations in the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: We estimated that most patients in our population would prefer triple therapy as initial treatment (78%) or after an inadequate response to methotrexate (62%). The probability of choosing triple therapy as initial treatment was further from 50% (the point of indifference) for more patients, making our prediction more confident, and suggesting a stronger recommendation could be made. After an inadequate response to methotrexate, the choice was more split, suggesting a decision aid may be helpful. CONCLUSION: Using a novel approach, we estimated that many patients with early rheumatoid arthritis may prefer triple therapy to other treatment options, in contrast to existing guidelines. This offers an approach that may help inform Grading of Recommendations Assessment, Development, and Evaluation treatment recommendations.
Authors: Brian S Alper; Peter Oettgen; Ilkka Kunnamo; Alfonso Iorio; Mohammed Toseef Ansari; M Hassan Murad; Joerg J Meerpohl; Amir Qaseem; Monica Hultcrantz; Holger J Schünemann; Gordon Guyatt Journal: BMJ Open Date: 2019-06-04 Impact factor: 2.692
Authors: Glen S Hazlewood; Deborah A Marshall; Claire E H Barber; Linda C Li; Cheryl Barnabe; Vivian Bykerk; Peter Tugwell; Pauline M Hull; Nick Bansback Journal: Patient Prefer Adherence Date: 2020-05-18 Impact factor: 2.711
Authors: Glen S Hazlewood; Gyanendra Pokharel; Robert Deardon; Deborah A Marshall; Claire Bombardier; George Tomlinson; Christopher Ma; Cynthia H Seow; Remo Panaccione; Gilaad G Kaplan Journal: PLoS One Date: 2020-01-16 Impact factor: 3.240