Suz Jack Chan1, Lisa K Stamp2, Nicola Liebergreen1,3, Henry Ndukwe1, Carlo Marra1, Gareth J Treharne4. 1. School of Pharmacy, University of Otago, Dunedin, New Zealand. 2. Department of Medicine, University of Otago, Christchurch, New Zealand. 3. Faculty of Law, University of Otago, Dunedin, New Zealand. 4. Department of Psychology, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. gareth.treharne@otago.ac.nz.
Abstract
BACKGROUND AND OBJECTIVE: Biologic therapies are cost effective for active rheumatoid arthritis but have adverse effects and are costly. Tapering of biologics is emerging as an important consideration when sustained remission is achieved. Recent trials have highlighted the clinical feasibility of tapering, but there is little evidence on how proposed tapering would be received by patients. The aim of this study was to explore factors influencing hypothetical decisions of patients with rheumatoid arthritis on tapering their biologics and their perspectives on remission and flare when considering the possibility of tapering. METHODS: Patients with rheumatoid arthritis with diverse experiences of biologics with different modes of administration were purposively sampled to participate in one of six focus groups (n = 43) or an individual interview (n = 2). Transcripts were analyzed using inductive thematic analysis. RESULTS: Five overarching themes on what influences a participant's decision to taper their biologic were identified. First, participants were fearful of uncertain outcomes of tapering, especially flare and joint damage. Second, participants prioritized quality of life from continuing biologics over the risk of adverse effects. Third, tapering biologics was seen as providing relief from the inconvenience of taking biologics regularly. Fourth, participants wanted assurance of prompt access to healthcare if their rheumatoid arthritis were to flare when tapering. Fifth, preferences for involvement in decision making varied, but fulfilling information needs was desired to aid a patient's preferred role in decision making on tapering. CONCLUSIONS: This study provides novel insight into the perspectives of patients with rheumatoid arthritis on tapering biologics when sustained remission is achieved at a crucial juncture in global affordability for healthcare systems. These patient perspectives can inform the planning of decision aids and clinical trials of decision-making processes when tapering is proposed.
BACKGROUND AND OBJECTIVE: Biologic therapies are cost effective for active rheumatoid arthritis but have adverse effects and are costly. Tapering of biologics is emerging as an important consideration when sustained remission is achieved. Recent trials have highlighted the clinical feasibility of tapering, but there is little evidence on how proposed tapering would be received by patients. The aim of this study was to explore factors influencing hypothetical decisions of patients with rheumatoid arthritis on tapering their biologics and their perspectives on remission and flare when considering the possibility of tapering. METHODS:Patients with rheumatoid arthritis with diverse experiences of biologics with different modes of administration were purposively sampled to participate in one of six focus groups (n = 43) or an individual interview (n = 2). Transcripts were analyzed using inductive thematic analysis. RESULTS: Five overarching themes on what influences a participant's decision to taper their biologic were identified. First, participants were fearful of uncertain outcomes of tapering, especially flare and joint damage. Second, participants prioritized quality of life from continuing biologics over the risk of adverse effects. Third, tapering biologics was seen as providing relief from the inconvenience of taking biologics regularly. Fourth, participants wanted assurance of prompt access to healthcare if their rheumatoid arthritis were to flare when tapering. Fifth, preferences for involvement in decision making varied, but fulfilling information needs was desired to aid a patient's preferred role in decision making on tapering. CONCLUSIONS: This study provides novel insight into the perspectives of patients with rheumatoid arthritis on tapering biologics when sustained remission is achieved at a crucial juncture in global affordability for healthcare systems. These patient perspectives can inform the planning of decision aids and clinical trials of decision-making processes when tapering is proposed.
Authors: Sytske Anne Bergstra; Jaime C Branco; David Vega-Morales; Karen Salomon-Escoto; Nimmisha Govind; Cornelia F Allaart; Robert B M Landewé Journal: Ann Rheum Dis Date: 2018-07-06 Impact factor: 19.103
Authors: Anthony M Louder; Amitabh Singh; Kim Saverno; Joseph C Cappelleri; Aaron J Aten; Andrew S Koenig; Margaret K Pasquale Journal: Am Health Drug Benefits Date: 2016-04
Authors: Jasvinder A Singh; Kenneth G Saag; S Louis Bridges; Elie A Akl; Raveendhara R Bannuru; Matthew C Sullivan; Elizaveta Vaysbrot; Christine McNaughton; Mikala Osani; Robert H Shmerling; Jeffrey R Curtis; Daniel E Furst; Deborah Parks; Arthur Kavanaugh; James O'Dell; Charles King; Amye Leong; Eric L Matteson; John T Schousboe; Barbara Drevlow; Seth Ginsberg; James Grober; E William St Clair; Elizabeth Tindall; Amy S Miller; Timothy McAlindon Journal: Arthritis Rheumatol Date: 2015-11-06 Impact factor: 10.995