Study Explores Patient Preferences in Second-Line RA Treatment Options


Patients with rheumatoid arthritis (RA) were asked their preferences of second-line treatment options such as biologics and Janus kinase inhibitors, taking into account such factors as the probability of severe side effects, treatment effectiveness, administration route, and more.

A recent study from Sweden of patients with rheumatoid arthritis (RA) found that when it comes to second-line treatment options such as biologics or Janus kinase inhibitors, most thought that effectiveness, route of administration, or severe side effects are the most important factors to consider.

Patient-centered care has increasingly accepted the view that patient preferences regarding various treatment options are important to take into account and play a role in clinical decision making and regulatory approvals. However, the authors wrote that there is a lack of evidence about the level of side effects patients are willing to accept in second-line treatments.

In this study, patients with RA were recruited through various means to participate in a survey containing demographic and disease-related questions. The survey used a discrete choice experiment, a cross-sectional survey method that assesses preferences in a quantitative way.

Data collection took place between November 2018 to August 2019. Participants were asked to pick their preferred treatment from 2 alternatives.

Out of 422 patients who completed the survey, 358 were included in the final latent class analysis. Most were female (77%) and spanned all age categories between 18 and 80 years.

Overall, patients preferred:

  • A tablet and injection over a drip
  • Monthly over weekly or daily medication
  • The medicine with the highest effectiveness

The most important characteristic of treatment cited by patients were the probability of severe side effects, treatment effectiveness, probability of psychological side effects, administration route, frequency of use, probability of mild short-term side effects, and probability of side effects changing appearance, in that order.

Across all participants, treatments with the highest frequency of side effects were strongly disfavored.

However, disease duration influenced the patients’ choices, and those rating treatment effectiveness as the most important attribute were more willing than other participants to accept higher risks of side effects.

The study also measured the minimum acceptable benefit (MAB) levels needed, expressed in percentage point increases in effectiveness, to make up for worsening levels of probability of certain side effects. Due to preference heterogeneity, large differences were found in the MAB across the 3 classes found in the analysis. In class 1, only a small benefit was needed to accept a switch to a less favorable frequency of side effects. Participants in the other 2 classes would require a larger increase in effectiveness to accept an increase in risk of side effects.

The study had some limitations, such as the fact that patients were recruited from multiple sources (RA clinics, a patient organization, and online) so it was not possible to calculate the response rate. But the authors said no duplicates were found in the patient sample. As the study took place in Sweden, the results may not be generalizable to certain other countries with different health systems.

The researchers suggested that future work could include disease activity and risk propensity, which may influence patient preferences, as well as the development of guidelines to include patient preference assessments in regulatory approvals.


Schölin Bywall K, Kihlbom U, Hansson M, et al. Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients. Arthritis Res Ther. Published online December 19, 2020. doi: 10.1186/s13075-020-02391-w

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