Impact of treatment experience on patient preferences and disease burden in psoriatic arthritis: results from a rheumatology patient research registry

Abstract

Background/Purpose: To optimize patient-provider shared decision-making, it is important to understand patients’ experience with psoriatic arthritis (PsA) and its treatment, including how treatment experience may impact their preferences. We evaluated PsA symptom burden, the most important impacts of disease, and therapy preferences based on past biologic disease-modifying antirheumatic drug (bDMARD) experience among PsA patients from the ArthritisPower registry. Methods: A cross-sectional, web-based survey was developed and administered to adults with a self-reported diagnosis of PsA recruited from a United States rheumatology patient-centered research registry, ArthritisPower. Object case best-worst scaling (BWS) was used to evaluate the relative burden of 11 PsA symptoms and the relative importance of improvement in 9 PsA-related disease impacts. BWS data were analyzed using a random parameters logit model stratified by past bDMARD experience. Additional survey questions and analyses assessed the impact of prior treatment experience on patients’ experience with methotrexate (MTX) and preference for mode of treatment administration as well as overall treatment satisfaction. Results: Among 332 respondents, 74 (22.3%) were bDMARD-naïve and 258 (77.7%) were bDMARD-experienced. In both groups, musculoskeletal pain-related symptoms were reported as most bothersome while the least bothersome symptoms were psoriasis-related (Figure 1). Patients who were bDMARD-naïve rated morning stiffness as more bothersome than bDMARD-experienced patients. The ability to perform physical activities was reported as the most important disease impact to improve by both groups, while bDMARD-naïve patients rated improvement in sleep quality as more important compared to bDMARD-experienced patients (Figure 2). Among patients with MTX experience, a similar proportion of bDMARD-naïve patients (40%) and bDMARD-experienced patients (34%) were satisfied with MTX. A significantly greater proportion of bDMARD-naïve patients felt that mode of administration was an important factor when deciding to start a new therapy compared to bDMARD-experienced patients (57% vs. 42%, p< 0.05). When asked to choose among four different ways of taking their PsA medication (oral once or twice per day, injection every 2 weeks or every month), a once daily oral tablet was the most commonly chosen mode by both bDMARDnaïve (39%) and -experienced patients (38%). Overall satisfaction with current treatment was higher among patients taking an advanced therapy (bDMARDs or tofacitinib) compared with those taking conventional DMARDs only (72% vs 39%, p< 0.05). Conclusion: Among patients with PsA, musculoskeletal pain-related symptoms were ranked as most bothersome, and improvements in physical function were ranked as most important, regardless of bDMARD treatment experience. Though mode of administration was rated as more important among bDMARD-naïve patients, both bDMARD-naïve and -experienced patients preferred a once daily oral route of administration. These findings may serve to optimize patient-provider treatment discussion and decision making across PsA patient populations.