Patient Preferences in the Choice of Disease Modifying Anti- Rheumatic Drugs

Background There is a variety of biologic and conventional synthetic disease modifying anti-rheumatic drugs (DMARDs) available for the treatment of rheumatoid arthritis (RA). These DMARDs are associated with different characteristics in key attributes such as mode of administration, side effects, etc. Importantly, biological DMARDs (bDMARDs) are all administered parenterally.1 However, targeted synthetic DMARDs offer alternative administration forms (i.e. oral administration). To address patient preferences and to inform decision making regarding such characteristics, a quantitative approach is needed. Objectives The current study assesses the importance of such treatment characteristics for RA patients' preferences using a discrete choice experiment (DCE) in an ecologically valid design. Methods In a questionnaire-based DCE, 2,072 RA patients were asked to choose the “most” and “least preferred DMARD” (best-worst-scaling) among hypothetical multi-attribute treatment options with varying levels of key attributes, as defined in focus groups: mode of administration, frequency of administration, time until onset of drug effect, necessity of combination therapy with methotrexate, and side effects. A design with multi-attribute products (multi-profile case) simulates a real choice situation between different treatment alternatives.2 Each questionnaire included eight DCE scenarios. Results Analyses included 1,588 patients (drop-out rate: 23%) from 40 office based rheumatologists across Germany. Majority of patients were female (74%), 50 to 64 years of age (45%), with <10 years of disease duration (56%), and reported experience with injectable DMARDs (63%). Mode of administration appeared the most important attribute guiding patients' preferences, with ‘oral application’ being most desired (selected as best option in 49% of the cases) and infusion being least preferred (worst option in 46% of the cases). The second most relevant attribute was “necessity of combination therapy with methotrexate”, with DMARDs not requiring combination being most preferred (in 43% of the cases), followed by frequency of administration, side effects and time to onset of effect. Conclusions The present study aims to determine the relative importance of DMARD characteristics for RA patient preferences. Analyses were based on an RA sample with typical epidemiological characteristics – suggesting a representative sample – and prior experience with injectable DMARDs by majority. Results indicate that, of included attributes, the most important ones are route of administration (oral being the number one choice by majority) and combination therapy with methotrexate (DMARDs not requiring such combination being most preferred) for RA patients' choice. References Smolen JS, et al. (2014) Ann Rheum Dis, 73(3): 429-509 Finn A, Louviere J (1992) J Public Policy Mark, 11(1): 12-25 Acknowledgements Study sponsored by Pfizer GmbH Disclosure of Interest K. Krüger Consultant for: Abbvie, BMS, Medac, MSD, Pfizer, Roche, UCB, Speakers bureau: Abbvie, BMS, Medac, MSD, Pfizer, Roche, UCB, R. Alten Grant/research support from: Pfizer Inc., Speakers bureau: Pfizer Inc., J. Schiffner-Rohe Shareholder of: Pfizer Inc., Employee of: Pfizer Deutschland GmbH, O. Behmer Shareholder of: Pfizer Inc, Employee of: Pfizer Pharma GmbH, G. Schiffhorst Grant/research support from: Pfizer Pharma GmbH, J. Rellecke Grant/research support from: Pfizer Pharma GmbH, H.-D. Nolting Grant/research support from: Pfizer Pharma GmbH