Treatment Mode Preferences in Psoriatic Arthritis: A Qualitative Multi-Country Study

Abstract

Objective: Qualitative research exploring patient preferences regarding the mode of treatment administration for psoriatic arthritis (PsA) is limited. We report patient preferences and their reasons across PsA treatment modes.

Methods: In this global, cross-sectional, qualitative study, interviews were conducted with adult patients with PsA in Brazil, France, Germany, Italy, Spain, the UK, and the US. Patients were currently taking a disease-modifying antirheumatic drug (DMARD). Patients indicated the order and strength of preference (0-100; 100 = strongest) across four modes of treatment administration: oral (once daily), self-injection (weekly), clinic injection (weekly), and infusion (monthly); reasons for preferences were qualitatively assessed. Descriptive statistics were reported. Fisher's exact tests and t-tests were conducted for treatment mode outcomes.

Results: Overall, 85 patients were interviewed (female, 60.0%; mean age, 49.8 years). First-choice ranking (%) and mean [standard deviation] preference points were: oral (49.4%; 43.9 [31.9]); self-injection (34.1%; 32.4 [24.8]); infusion (15.3%; 14.5 [20.0]); clinic injection (1.2%; 9.2 [10.0]). Of 48 (56.5%) patients with a strong first-choice preference (ie point allocation ≥60), 66.7% chose oral administration. Self-injection was most often selected as second choice (51.8%), clinic injection as third (49.4%), and infusion as fourth (47.1%). Oral administration was the first-choice preference in the US (88.0% vs 38.0% in Europe). The most commonly reported reason for oral administration as the first choice was speed and ease of administration (76.2%); for self-injection, this was convenience (75.9%). The most commonly reported reason for avoiding oral administration was concern about possible drug interactions (63.6%); for self-injection, this was a dislike of needles or the injection process (66.7%).

Conclusion: Patients with PsA preferred oral treatment administration, followed by self-injection; convenience factors were common reasons for these preferences. Overall, 43.5% of patients did not feel strongly about their first-choice preference and may benefit from discussions with healthcare professionals about PsA treatment administration options.

Keywords: patient preference; psoriatic arthritis; qualitative research; treatment administration.

Figure 1

Mode of treatment administration ranking and point allocation^a. (A) First-choice^b mode of treatment administration (ranking) and (B) mode of treatment administration 100-point allocation means (N = 85). ^aPatients were asked ‘assuming equal effectiveness, safety, and cost, if you had 100 points to assign across these four modes of administration to reflect your preferences, how would you allocate these points? The more points you give to a mode means the more you prefer that mode of administration. You can assign as many or as few points, even zero points, as you want to each of the four modes, so long as the points across all four modes sum to 100.’ ^bA patient’s first-choice mode was the mode with the most points allocated; a “strong” first-choice preference was defined as a mode with point allocation ≥60. Abbreviations: QD, once per day; QMT, once per month; QW, once per week; SD, standard deviation.

Figure 2

Most common^a reasons^b for choosing and not choosing the most preferred mode of administration. ^aReported by ≥25% of patients. ^bPatients were asked about how they had assigned their 100 points to the modes of treatment administration: “Why is your first-choice mode your first choice? Why is that important to you? What else makes it your first choice? Why is your second/third/fourth choice so far/close in preference to your first/second/third choice? What do you like about your second/third/fourth-choice mode? What do you dislike about your second/third/fourth-choice mode? What else, if anything, is related to your first-choice mode being your most preferred way to take your PsA treatment? How, if at all, do you think that your past experiences with treatments for PsA or treatments for any other conditions affect your preference for your first-choice mode? Like what?”. Abbreviation: PsA, psoriatic arthritis.

Figure 3

First-choice mode of treatment administration preference and preference points, by region. *P < 0.05; **P < 0.01; ***P < 0.001 vs the US. ^aIncludes France, Germany, Italy, Spain and the UK. Abbreviations: QD, once per day; QMT, once per month; QW, once per week; SD, standard deviation.