Openness to and preference for attributes of biologic therapy prior to initiation among patients with rheumatoid arthritis: patient and rheumatologist perspectives and implications for decision making

Figures & data

Table 1 Patient demographics and disease characteristics

	Creaky Joints panel		Consumer panel		Total
	%/Mean ± SD	N	%/Mean ± SD	N	%/Mean ± SD	N
Age	45.77*±12.22	101	57.27±11.63	142	52.49±13.14	243
Female	93.1	94*	79.6	113	85.2	207
White	88.1	89	83.8	119	85.6	208
Married	58.4	59	56.3	80	57.2	139
Employed full-time	33.7	34*	19.7	28	25.5	62
College degree	59.4	60*	43.0	61	49.8	121
Medicare insurance	20.8	21*	41.5	59	32.9	80
Years since start of RA symptoms	10.18*±9.99	101	14.83±12.50	142	12.90±11.73	243
Joint damage due to RA	60.4	61	65.5	93	63.4	154

Note:

* P<0.05 for comparisons across panels, within each row.

Abbreviations: RA, rheumatoid arthritis; SD, standard deviation.

Table 2 Rheumatologist characteristics

	%/Mean ± SD	N
Age	49.18±8.83	103
Female	27.2	28
White	72.8	75
Number of years in practice as rheumatologist	14.42±6.39	103
Number of patients with RA treated per month	125.58±51.38	103
Infusion suite in office	80.6	83

Abbreviations: RA, rheumatoid arthritis; SD, standard deviation.

Table 3 Patients’ and rheumatologists’ perceptions of patient openness to route of administration and attributes of biologic therapies

	Patients (N=243)		Rheumatologists (N=103)
	%	N	Mean % ± SD%
Route of administration
IV only	14.0	34	13.0±8.83
SQ only	16.5	40	34.0±19.6
Both IV and SQ	53.1	129	40.7±23.9
Neither	16.5	40	12.3±9.8
	Mean ± SD		Mean ± SD
Attributes of biologic therapies
Self-injection, every 4 weeks or monthly	3.37±1.38		4.29±0.60
Self-injection, every 2 weeks	3.06±1.33		3.95±0.65
IV, taking 30 minutes, every 8 weeks	2.86±1.35		3.75±0.79
Self-injection, once a week	2.80±1.33		3.43±0.72
IV, taking 30 minutes, every 4 weeks	2.60±1.33		3.30±0.85
Self-injection, twice a week	2.44±1.22		2.58±0.82
IV, taking 1 hour, every 4 weeks	2.42±1.21		3.15±0.80
IV, taking 2 hours, every 8 weeks	2.33±1.22		3.42±0.75
IV, taking 2 hours, every 4 weeks	2.19±1.16		2.79±0.79
IV, two infusions taking 5 hours, separated by 2 weeks, every 16–24 weeks	2.13±1.24		3.00±0.93

Notes: Presented for route of administration is the proportion of all patients reporting openness to each route and, as reported by rheumatologists, the mean proportion of patients estimated to be open to each route. Presented for attributes of biologic therapies are the mean openness (1= not at all open to 5= extremely open) of patients to each attribute, as reported by individual patients or as estimated by rheumatologists for the average patient.

Abbreviations: IV, intravenous infusion; SD, standard deviation; SQ, subcutaneous injection.

Table 4 Patient and rheumatologist perceptions of patient preferences for route of administration and attributes of biologic therapies

	Patient (N=243)		Prescriber (N=103)
	%	N	Mean % ± SD%
Route of administration
Strongly prefer SQ	26.3	64	35.2±24.4
Somewhat prefer SQ	23.0	56	17.0±11.5
No preference	22.2	54	31.3±26.4
Somewhat prefer IV	16.5	40	8.3±7.4
Strongly prefer IV	11.9	29	8.1±7.0
	Mean ± SD		Mean ± SD
Attributes of biologic therapies
Self-injection, every 4 weeks or monthly	35.09±33.06		23.28±13.56
Self-injection, every 2 weeks	9.37±9.62		14.63±7.40
IV, taking 30 minutes, every 8 weeks	13.89±19.49		13.10±8.59
Self-injection, once a week	9.83±16.82		11.34±11.24
IV, taking 30 minutes, every 4 weeks	8.05±13.19		8.02±6.34
Self-injection, twice a week	5.45±11.01		3.89±4.60
IV, taking 1 hour, every 4 weeks	5.16±9.43		6.23±4.70
IV, taking 2 hours, every 8 weeks	5.08±9.73		7.56±5.42
IV, taking 2 hours, every 4 weeks	3.33±5.81		4.54±3.44
IV, two infusions taking 5 hours, separated by 2 weeks, every 16–24 weeks	4.77±10.48		7.40±6.49

Notes: Presented for route of administration is the proportion of all patients reporting preference for each route and, as reported by rheumatologists, the mean proportion of patients estimated to prefer each route. Presented for attributes of biologic therapies are the mean preference point allocations (100 points distributed across attributes) of patients to each attribute, as reported by individual patients or as estimated by rheumatologists for the average patient.

Abbreviations: IV, intravenous infusion; SD, standard deviation; SQ, subcutaneous injection.

Table 5 Rheumatologist perceptions of patient preferences versus patient preferences, stratified by patient characteristics

	Patient			Rheumatologist
	Prefer SQ % (N)	No preference % (N)	Prefer IV % (N)	Prefer SQ % (N)	No preference % (N)	Prefer IV % (N)
Older (≥65)	51.2 (22)	27.9 (12)	20.9 (9)	9.7 (10)	41.7 (43)	48.5 (50)
Younger (<65)	49.0 (98)	21.0 (42)	30.0 (60)	68.9 (71)	31.1 (32)	0.0 (0)
Male	50.2 (104)	19.8 (41)	30.0 (62)	28.2 (29)	66.0 (68)	5.8 (6)
Female	44.4 (16)	36.1 (13)	19.4 (7)	20.4 (21)	73.8 (76)	5.8 (6)
Medicare	58.6 (17)	20.7 (6)	20.7 (6)	3.9 (4)	25.2 (26)	70.9 (73)
Medicaid	50.8 (30)	18.6 (11)	30.5 (18)	18.4 (19)	63.1 (65)	18.4 (19)
Commercial insurance	45.2 (52)	25.2 (29)	29.6 (45)	40.8 (42)	56.3 (58)	2.9 (3)
Employed	50.5 (48)	25.3 (24)	24.2 (23)	72.8 (75)	25.2 (26)	1.9 (2)
Unemployed	48.6 (72)	20.3 (30)	31.1 (46)	10.7 (11)	71.8 (74)	17.5 (18)
Advanced joint damage	51.9 (80)	20.8 (32)	27.3 (42)	3.9 (4)	61.2 (63)	35.0 (36)

Notes: Presented are row percentages within patients (ie, proportion of each patient subgroup endorsing a particular preference) and rheumatologists (ie, proportion of all rheumatologists believing that each patient subgroup endorses a particular preference).

Abbreviations: IV, intravenous infusion; SQ, subcutaneous injection.

Figure 1 Person initiating discussion about starting biologic therapy.

Figure 2 Patient’s role in making final treatment decisions.

Table 6 Aspects of biologic therapy discussed by patients and rheumatologists

	Patient responses			Rheumatologist responses
	Not discussed at all (%)	Discussed somewhat (%)	Discussed in detail (%)	Not discussed at all (%)	Discussed somewhat (%)	Discussed in detail (%)
Preexisting medical conditions	32.9	32.1	35.0	3.9	32.0	34.1
Interactions with other medications	43.2	35.8	21.0	4.9	41.7	53.4
Potential side effects	25.5	36.6	37.9	0.0	11.7	88.3
Ability to slow joint damage	23.9	47.3	28.8	1.0	20.4	78.6
Ability to stop joint damage	25.9	50.6	23.5	1.0	22.3	76.7
Ability to improve mobility/range of motion	26.7	49.0	24.3	4.9	30.1	65.0
Ability to improve well-being and daily function	19.3	49.8	30.9	1.0	21.4	77.7
Effectiveness compared to other medications	21.4	52.3	26.3	1.0	31.1	68.0
Appropriateness for RA	12.3	43.2	44.4	1.0	18.4	80.6
Patient ability to attend infusion appointments	60.5	24.7	14.8	2.9	41.7	55.3
Treatment administered by a health care professional	43.2	35.4	21.4	6.8	61.2	32.0
Importance of taking medication as prescribed	34.2	35.8	30.0	1.9	25.2	72.8
Injection reactions	50.6	29.2	20.2	1.9	40.8	57.3
Pain/burning/discomfort during injections	56.4	29.6	14.0	2.9	53.4	43.7
Patient ability to safely manage SQ	43.2	32.9	23.9	0.0	37.9	62.1
IV experience	69.1	21.8	9.1	4.9	54.4	40.8
SQ experience	65.8	22.2	11.9	1.0	45.6	53.4
How treatment is administered	23.0	40.3	36.6	1.0	19.4	79.6
Length of treatment availability	51.4	33.7	14.8	3.9	48.5	47.6
Caregiver can manage administration	65.0	23.0	11.9	5.8	65.0	29.1
Treatment support programs by manufacturer	64.2	27.2	8.6	7.8	55.3	36.9
Out-of-pocket cost for treatment	53.5	30.5	16.0	3.9	46.6	49.5
Financial support programs by manufacturer	61.7	28.8	9.5	5.8	44.7	49.5
Ability to take medication without DMARD	41.2	35.8	23.0	5.8	41.7	52.4
Frequency of administration	25.9	36.6	37.4	0.0	20.4	79.6
Other	5.8	2.5	4.1	2.9	1.0	5.8

Notes: Presented are row percentages within patients and rheumatologists (ie, proportion of all patients or rheumatologists, respectively, endorsing a particular response).

Abbreviations: DMARD, disease-modifying antirheumatic drug; IV, intravenous infusion; RA, rheumatoid arthritis; SQ, subcutaneous injection.

Figure 3 Temporal impact of RA considered by patients when making treatment decisions.

Abbreviation: RA, rheumatoid arthritis.