Prevalence and Factors Associated With Patient-Clinician Discordance Among Patients With Rheumatoid Arthritis Initiating Advanced Therapy

Abstract

Objective: To describe and identify associated factors for patient-clinician discordance of disease assessment at biologic or Janus kinase inhibitor (JAKi) initiation and over 12 months following initiation in patients with rheumatoid arthritis (RA) from a US RA registry.

Methods: Analyses included CorEvitas RA Registry patients who initiated their first biologic or JAKi on or after February 1, 2015, and had 6- and 12-month follow-up visits. Positive discordance was defined as patient global assessment (visual analog scale [VAS-100]) minus physician's global assessment (VAS-100) equal to 30 points or more. Persistent discordance was defined as positive discordance at all three visits. Mixed-effects logistic regression was used to determine risk factors for positive discordance at initiation and for persistent discordance.

Results: Among 2227 first-time biologic/JAKi-initiating patients, 613 had both follow-up visits available and were included in initiation visit analyses, and of these, 163 had positive discordance at initiation and were included in persistent discordance analyses. About 30% of all patients had positive discordance at any visit, and one third of these (10% total) were persistent at all three visits. Multivariable analyses revealed that worse scores on the Clinical Disease Activity Index, greater patient-reported pain and fatigue, and greater functional impairment were associated with positive discordance at the time of therapy initiation. Being disabled versus working full-time and being female were associated with higher odds and having Medicare versus no insurance was associated with lower odds of having persistent positive discordance.

Conclusion: Results suggest positive discordance is common among real-world patients with RA initiating their first biologic or JAKi. The identified risk factors associated with patient-clinician discordance will help clinicians foster a more patient-centric discussion in treatment decisions.

Figure 1

Shift table for positive and no discordance across time points for total patient population, excluding patients with negative discordance. ^aAmong patients with positive discordance at the index visit, there were two who had either missing patient or physician global assessment at the 6‐month follow‐up. ^bAmong patients with positive discordance at the index visit and no discordance at the 6‐month follow‐up, there were two who had either missing patient or physician global assessment at the 12‐month follow‐up. ^cAmong patients with no discordance at the index visit, there were 23 who had either missing patient or physician global assessment at the 6‐month follow‐up. ^dAmong patients with no discordance at the index visit and positive discordance at the 6‐month follow‐up, there was one who had either missing patient or physician global assessment at the 12‐month follow‐up. ^eAmong patients with no discordance at the index visit and no discordance at the 6‐month follow‐up, there were 14 who had either missing patient or physician global assessment at the 12‐month follow‐up.

Figure 2

Predicted probability of positive discordance at different values of the CDAI (A) and patient‐reported pain (B) with 95% confidence intervals and distribution of CDAI and patient‐reported pain.