Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2004 Mar 5;63(11):1372–1378. doi: 10.1136/ard.2003.019422

Patient preferences for treatment of rheumatoid arthritis

L Fraenkel 1, S Bogardus 1, J Concato 1, D Felson 1, D Wittink 1
PMCID: PMC1754807  PMID: 15020312

Abstract

Objective: To elicit treatment preferences of patients with rheumatoid arthritis (RA) for disease modifying antirheumatic drugs (DMARDs) with varying risk profiles.

Methods: Patient values for 16 DMARD characteristics were ascertained using published data about side effects, effectiveness, and cost. Patient preferences were determined by Adaptive Conjoint Analysis, an interactive computer program that predicts preferences by asking patients to make trade-offs between specific treatment characteristics. Simulations were run to derive preferences for four drugs: methotrexate, gold, leflunomide, and etanercept, under different risk-benefit scenarios. Infliximab was not included because it is given with methotrexate, and we did not include preferences for combination therapy. Based on each patient's expressed preferences, and the characteristics of the treatments available at the time of the study, the option that best fitted each patient's perspective was identified.

Results: 120 patients (mean age 70 years) were interviewed. For the base case scenario (which assumed the maximum benefits reported in the literature, a low probability of adverse effects, and low equal monthly "co-pays" (out of pocket costs)), 95% of the respondents preferred etanercept over the other treatment options. When all four options were described as being equally effective, 88% continued to prefer etanercept owing to its safer short term adverse effect profile. Increasing etanercept's co-pay to $30.00 decreased the percentage of patients preferring this option to 80%.

Conclusions: In this study, older patients with RA, when asked to consider trade-offs between specific risk and benefits, preferred etanercept over other treatment options. Preference for etanercept is explained by older patients' risk aversion for drug toxicity.

Full Text

The Full Text of this article is available as a PDF (112.3 KB).

Figure 1.

Figure 1

Open in a new tab

 y axis: change in utility reflects how much patients valued elimination of the risk of specific adverse effects or maximal gains in improvement. x axis: range of benefits and risk of adverse effects associated with the DMARDs studied. Yellow: drug characteristics describing benefits; blue: drug characteristics describing common reversible adverse effects; red: drug characteristics describing less common, but potentially more serious, adverse effects.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bathon J. M., Martin R. W., Fleischmann R. M., Tesser J. R., Schiff M. H., Keystone E. C., Genovese M. C., Wasko M. C., Moreland L. W., Weaver A. L. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med. 2000 Nov 30;343(22):1586–1593. doi: 10.1056/NEJM200011303432201. [DOI] [PubMed] [Google Scholar]
  2. Edwards Adrian, Elwyn Glyn, Mulley Al. Explaining risks: turning numerical data into meaningful pictures. BMJ. 2002 Apr 6;324(7341):827–830. doi: 10.1136/bmj.324.7341.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Felson D. T., Anderson J. J., Meenan R. F. Use of short-term efficacy/toxicity tradeoffs to select second-line drugs in rheumatoid arthritis. A metaanalysis of published clinical trials. Arthritis Rheum. 1992 Oct;35(10):1117–1125. doi: 10.1002/art.1780351003. [DOI] [PubMed] [Google Scholar]
  4. Fraenkel L., Bogardus S., Concato J., Felson D. Preference for disclosure of information among patients with rheumatoid arthritis. Arthritis Rheum. 2001 Apr;45(2):136–139. doi: 10.1002/1529-0131(200104)45:2<136::AID-ANR165>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
  5. Fraenkel Liana, Bogardus Sidney, Concato John, Felson David. Risk communication in rheumatoid arthritis. J Rheumatol. 2003 Mar;30(3):443–448. [PubMed] [Google Scholar]
  6. Fries J. F., Spitz P. W., Williams C. A., Bloch D. A., Singh G., Hubert H. B. A toxicity index for comparison of side effects among different drugs. Arthritis Rheum. 1990 Jan;33(1):121–130. doi: 10.1002/art.1780330117. [DOI] [PubMed] [Google Scholar]
  7. Genovese Mark C., Bathon Joan M., Martin Richard W., Fleischmann Roy M., Tesser John R., Schiff Michael H., Keystone Edward C., Wasko Mary Chester, Moreland Larry W., Weaver Arthur L. Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum. 2002 Jun;46(6):1443–1450. doi: 10.1002/art.10308. [DOI] [PubMed] [Google Scholar]
  8. Ho M., Lavery B., Pullar T. The risk of treatment. A study of rheumatoid arthritis patients' attitudes. Br J Rheumatol. 1998 Apr;37(4):459–460. doi: 10.1093/rheumatology/37.4.459. [DOI] [PubMed] [Google Scholar]
  9. Kassirer J. P. Incorporating patients' preferences into medical decisions. N Engl J Med. 1994 Jun 30;330(26):1895–1896. doi: 10.1056/NEJM199406303302611. [DOI] [PubMed] [Google Scholar]
  10. Kremer J. M., Alarcón G. S., Weinblatt M. E., Kaymakcian M. V., Macaluso M., Cannon G. W., Palmer W. R., Sundy J. S., St Clair E. W., Alexander R. W. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review. Arthritis Rheum. 1997 Oct;40(10):1829–1837. doi: 10.1002/art.1780401016. [DOI] [PubMed] [Google Scholar]
  11. Kremer J. M. Safety, efficacy, and mortality in a long-term cohort of patients with rheumatoid arthritis taking methotrexate: followup after a mean of 13.3 years. Arthritis Rheum. 1997 May;40(5):984–985. doi: 10.1002/art.1780400533. [DOI] [PubMed] [Google Scholar]
  12. Meenan R. F., Gertman P. M., Mason J. H. Measuring health status in arthritis. The arthritis impact measurement scales. Arthritis Rheum. 1980 Feb;23(2):146–152. doi: 10.1002/art.1780230203. [DOI] [PubMed] [Google Scholar]
  13. Moreland L. W., Baumgartner S. W., Schiff M. H., Tindall E. A., Fleischmann R. M., Weaver A. L., Ettlinger R. E., Cohen S., Koopman W. J., Mohler K. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)-Fc fusion protein. N Engl J Med. 1997 Jul 17;337(3):141–147. doi: 10.1056/NEJM199707173370301. [DOI] [PubMed] [Google Scholar]
  14. Pullar T., Wright V., Feely M. What do patients and rheumatologists regard as an 'acceptable' risk in the treatment of rheumatic disease? Br J Rheumatol. 1990 Jun;29(3):215–218. doi: 10.1093/rheumatology/29.3.215. [DOI] [PubMed] [Google Scholar]
  15. Rau R., Herborn G., Menninger H., Sangha O. Radiographic outcome after three years of patients with early erosive rheumatoid arthritis treated with intramuscular methotrexate or parenteral gold. Extension of a one-year double-blind study in 174 patients. Rheumatology (Oxford) 2002 Feb;41(2):196–204. doi: 10.1093/rheumatology/41.2.196. [DOI] [PubMed] [Google Scholar]
  16. Ryan M., McIntosh E., Shackley P. Methodological issues in the application of conjoint analysis in health care. Health Econ. 1998 Jun;7(4):373–378. doi: 10.1002/(sici)1099-1050(199806)7:4<373::aid-hec348>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  17. Sawyer Susan M., Fardy H. John. Bridging the gap between doctors' and patients' expectations of asthma management. J Asthma. 2003 Apr;40(2):131–138. doi: 10.1081/jas-120017983. [DOI] [PubMed] [Google Scholar]
  18. Strand V., Cohen S., Schiff M., Weaver A., Fleischmann R., Cannon G., Fox R., Moreland L., Olsen N., Furst D. Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Leflunomide Rheumatoid Arthritis Investigators Group. Arch Intern Med. 1999 Nov 22;159(21):2542–2550. doi: 10.1001/archinte.159.21.2542. [DOI] [PubMed] [Google Scholar]
  19. Suarez-Almazor M. E., Conner-Spady B., Kendall C. J., Russell A. S., Skeith K. Lack of congruence in the ratings of patients' health status by patients and their physicians. Med Decis Making. 2001 Mar-Apr;21(2):113–121. doi: 10.1177/0272989X0102100204. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES