Real-world patient experience and treatment preferences in patients with psoriatic arthritis

Abstract

Background: Despite recent advances in the treatment of psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. An understanding of patients’ experience with PsA and its treatment is needed to bring the patient’s perspective into treatment decision-making and development of new therapies.

Objectives: To better understand real-world PsA patients’ experience with PsA via evaluation of (1) the burden and importance of common PsA symptoms and disease impacts and (2) treatment preferences.

Methods: A cross-sectional, web-based survey was developed, informed by published literature and treatment guidelines, expert clinical opinion, and cognitive debriefing interviews with PsA patients. Adults with a self-reported diagnosis of PsA were recruited from a US rheumatology patient-centered research registry and other online patient communities. Object case best-worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in 9 PsA-related disease impacts. BWS data were analyzed using a random parameters logit model. Data on patient demographics and preferences for PsA treatment attributes, including experience with methotrexate and preference for route and frequency of administration, were analyzed descriptively.

Results: The sample of 247 respondents was 79% female, had a mean age of 53.4 years (range 24-79 years), and had a mean time since PsA diagnosis of 9.4 years, with 86% currently being treated by a rheumatologist. The most common PsA symptoms ever experienced were joint pain, morning stiffness and fatigue, while the least common symptom was skin pain/discomfort related to psoriasis patches. In the BWS, patients reported pain-related symptoms (i.e., joint pain and lower back or spine pain) as the most bothersome, while the least bothersome symptoms were psoriasis-related (Figure 1). Patients reported ability to perform physical activities as the most important disease impact to improve, followed by ability to live/function independently, sleep quality, and ability to do daily activities. Nearly half the sample (49%) stated they would strongly prefer a treatment for PsA that does not include methotrexate. Among patients who were not satisfied with methotrexate, the top reason was dislike of the short-term side effects after each dose. When asked to choose among four different ways of taking their PsA medication (oral once a day, oral twice a day, injection every 2 weeks, injection once a month), the most preferred method was oral once a day (38%) followed by injection once a month (26%), with 24% indicating no preference. Additionally, 49% of the sample felt that mode of administration was an important factor when deciding to start a new therapy.

Conclusion: Among real-world patients with PsA, the most bothersome PsA symptoms were related to pain while patients most wanted to improve functional impacts of their disease. Patients most preferred an oral once a day treatment option and treatment regimens that do not include methotrexate. These findings can serve to better inform development of new therapies and guide shared patient-provider treatment decision making.