Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 3;7(1):17.
doi: 10.1186/s41927-023-00341-y.

Physical function and severe side effects matter most to patients with RA (< 5 years): a discrete choice experiment assessing preferences for personalized RA treatment

Karin Schölin Bywall  1   2 , Bente Appel Esbensen  3   4 , Marie Heidenvall  5 , Inger Erlandsson  5 , Marta Lason  6 , Mats Hansson  7 , Jennifer Viberg Johansson  7   8
Affiliations

Physical function and severe side effects matter most to patients with RA (< 5 years): a discrete choice experiment assessing preferences for personalized RA treatment

Karin Schölin Bywall et al. BMC Rheumatol. .

Abstract

Aim: Early assessment of patient preferences has the potential to support shared decisions in personalized precision medicine for patients with rheumatoid arthritis (RA). The aim of this study was to assess treatment preferences of patients with RA (< 5 years) with previous experience of inadequate response to first-line monotherapy.

Method: Patients were recruited (March-June 2021) via four clinics in Sweden. Potential respondents (N = 933) received an invitation to answer a digital survey. The survey included an introductory part, a discrete choice experiment (DCE) and demographic questions. Each respondent answered 11 hypothetical choice questions as part of the DCE. Patient preferences and preference heterogeneity were estimated using random parameter logit models and latent class analysis models.

Results: Patients (n = 182) assessed the most important treatment attributes out of physical functional capacity, psychosocial functional capacity, frequency of mild side effects and likelihood of severe side effects. In general, patients preferred a greater increase in functional capacity and decreased side effects. However, a substantial preference heterogeneity was identified with two underlying preference patterns. The most important attribute in the first pattern was the 'likelihood of getting a severe side effect'. Physical functional capacity was the most important attribute in the second pattern.

Conclusion: Respondents focused their decision-making mainly on increasing their physical functional capacity or decreasing the likelihood of getting a severe side effect. These results are highly relevant from a clinical perspective to strengthen communication in shared decision making by assessing patients' individual preferences for benefits and risks in treatment discussions.

Keywords: Individualised treatment; Precision medicine; Rheumatoid arthritis; Shared decision-making.

PubMed Disclaimer

Conflict of interest statement

The authors KSB, MGH and JVJ declare no competing interests.

BAE has received speaking fees from Pfizer and Lilly.

MH and IE are supported by the Swedish Rheumatism Association as patient research partners. ML is employed at ELSA Science.

Figures

Fig. 1
Fig. 1
Example of a choice question
Fig. 2
Fig. 2
Relative importance of treatment attributes based on latent class analysis
See this image and copyright information in PMC

References

    1. Giacomelli R, et al. The growing role of precision medicine for the treatment of autoimmune diseases; results of a systematic review of literature and Experts' Consensus. Autoimmun Rev. 2021;20(2):102738. doi: 10.1016/j.autrev.2020.102738. - DOI - PubMed
    1. Aletaha D. Precision medicine and management of rheumatoid arthritis. J Autoimmun. 2020;110:102405. doi: 10.1016/j.jaut.2020.102405. - DOI - PubMed
    1. van Vollenhoven R. Treat-to-target in rheumatoid arthritis - are we there yet? Nat Rev Rheumatol. 2019;15(3):180–186. doi: 10.1038/s41584-019-0170-5. - DOI - PubMed
    1. Burmester GR, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet. 2017;389(10086):2338–2348. doi: 10.1016/S0140-6736(17)31491-5. - DOI - PubMed
    1. Barton JL, Décary S. New galaxies in the universe of shared decision-making and rheumatoid arthritis. Curr Opin Rheumatol. 2020;32(3):273–278. doi: 10.1097/BOR.0000000000000699. - DOI - PMC - PubMed

LinkOut - more resources