Most Patients With RA on Biologic DMARDs Prefer Self-administration

About one-third of patients prefer in-hospital administration, particularly if they are older or already make frequent visits to the hospital.

Most patients with rheumatoid arthritis (RA) would prefer to take DMARDS via self-administered subcutaneous injection, according to a new patient survey, though most patients said they would change their preference based on provider recommendations.

DMARDS, biologic and otherwise, have become a major component of the RA therapeutic landscape. DMARDS can typically be administered via self-injection, infusion in a hospital setting, or injection in a hospital setting. Writing in the journal Rheumatology and Therapy, corresponding author Mitsumasa Kishimoto, MD, PhD, of Kyorin University School of Medicine, in Japan, and colleagues, explained that existing scientific literature has yet to delve into the issue of which patients prefer which administration methods and settings, and why.

To find out, Kishimoto and colleagues created a web-based questionnaire and hired an internet research company to recruit patients who were at least 20 years old and who were receiving biologic DMARDS for RA. Enrollees were questioned about their preferred treatment mode and about any discrepancies between their preferred mode of administration and the mode they were receiving.

“We speculated that a better understanding of patient preferences for the treatment mode of bDMARDs, including those at the start of administration and those triggering a subsequent change in preference, would facilitate treatment selection and likely lead to improvements in patient satisfaction,” Kishimoto and colleagues wrote.

A total of 400 patients were recruited and answered questions about preferred treatment mode. Most (69.5%) were female, the average age was 55.7 years, and the patients had an average disease duration of 14.1 years.

Of the 400 patients who responded, two-thirds (66.8%) said they preferred self-administration at home.

“With regard to self-administered SC injection, the major patient background factor that affected patient preference for this mode was its flexible administration setting,” Kishimoto and colleagues reported, adding that younger patients (those under 40) were also more likely to prefer self-injection versus in-hospital administration.

Yet, 15.3% of patients said their preferred administration method was in-hospital infusion, and 18% said they preferred in-hospital injection. The investigators said patients who already made regular hospital visits and those who had anxiety or concerns about self-administration were more likely to want to visit the hospital to get their treatments. The investigators also found that some patients, particularly those receiving in-hospital infusion, worried that the effectiveness of the drug might change if they changed administration methods.

Most patients in the study said they were receiving their doses via their preferred method, including 94.0% of self-administering patients, 71.2% of patients receiving in-hospital injections, and 68.0% of patients receiving in-hospital infusion.

Still, the vast majority (93%) of patients appeared willing to consider other administration methods for reasons such as a provider recommendation or a change in their symptoms.

Kishimoto and colleagues said the survey underscores the value of shared decision-making and clear communication.

“During long-term RA treatment with bDMARDS, patient preferences for treatment mode following a change in their background should always be confirmed through physician-patient communication,” they concluded. “[Shared decision-making] is effective for determining patients’ preferred treatment mode of bDMARD, and is expected to become standard practice.”


Kishimoto M, Yamairi F, Sato N, Kobayashi J, Yamauchi S, Iwasaki T. Patient preference for treatment mode of biologics in rheumatoid arthritis: A 2020 web-based survey in Japan. Rheumatol Ther. Published online June 5, 2021. doi:10.1007/s40744-021-00325-9