OP0281-HPR Preferences of patients with rheumatoid arthritis regarding disease modifying anti-rheumatic drugs: a discrete choice experiment
Authors: M. Van Heuckelum, E. Mathijssen, M. Vervloet, A. Boonen, A. Pasma, R. Hebing, H. Vonkeman, M. Wenink, B. van den Bemt, L. van Dijk
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Adherence to disease modifying anti-rheumatic drugs (DMARDs) is suboptimal in rheumatoid arthritis (RA) patients. Adherence rates vary from 30% to 90%,<sup><sup>1</sup></sup> which may be partly due to patients' preferences regarding treatment benefits and drawbacks of DMARD therapy. Tailoring treatment options to these preferences might motivate patients to adhere to their drugs and eventually improve adherence. <h3>Objectives</h3> The primary objective is to identify subgroups in RA patients based on their preferences towards DMARD characteristics. The secondary objective is to identify characteristics associated with subgroup membership. <h3>Methods</h3> A discrete choice experiment (DCE) based on a literature review, expert recommendations and focus groups was used to elicit preferences in RA patients. Patients were asked to state their choice over two different hypothetical treatment options, which were described by seven DMARD characteristics and three levels within each characteristic (e.g. route of administration with the levels: oral, subcutaneous and intravenous). Patients were eligible to participate if they were diagnosed with RA according to the ACR/EULAR 2010 criteria, current user of at least one DMARD, and aged ≥18 years. Latent class analysis was used to identify subgroups based on stated preferences towards DMARD characteristics and multinomial logistic regression was used to identify characteristics (i.e. beliefs about medicines, patient- and disease-related variables) associated with subgroup membership. <h3>Results</h3> A total of 1317 RA patients were invited to participate in this study with an overall response rate of 24.8% (n=326). Three subgroups with segment sizes of 46.5% (SG1), 24.6% (SG2) and 28.9% (SG3) were found. SG1 was most strongly influenced by chance of efficacy, which contributed for 43.6% in their choice for a DMARD. In contrast with SG1, route of administration, risk of cancer and frequency of administration contributed most in SG2 (relative importance (RI) of 22.3%, 17.0% and 16.2% respectively). In SG3, route of administration (RI:38.2%) contributed most in their choice for a DMARD with a strong preference for tablets/capsules. Current and previous use of other cDMARDs (i.e. leflunomide, azathioprine, ciclosporin or gold therapy) and indifferent (low necessity, low concerns) beliefs were significantly associated with assignment to SG2 (Relative Risk Ratio (RRR) 6.03, p=0.0012, RRR=3.64, p=0.013 and RRR:14.91, p=0.003 respectively). Current and previous use of sulfasalazine, other cDMARDs, medium educational level and (early) retirement were significantly associated with assignment to SG3 (RRR:3.91, p=0.009; RRR:0.34, p=0.010, RRR:3.38, p=0.020, RRR:3.12, p=0.005 and RRR:0.358, p=0.034). <h3>Conclusions</h3> DCE data revealed that RA patients had different preferences for DMARD characteristics, which resulted in the identification of three subgroups. Integrating preferences of these subgroups in patient-tailored treatment decisions and the effect on medication adherence should be part of future research. <h3>Reference</h3> [1] Pasma A, et al. Arthritis Res Ther2015;1–10. doi:10.1186/s13075-015-0801-4 <h3>Disclosure of Interest</h3> None declared