Preference phenotypes to facilitate shared decision-making in rheumatoid arthritis

Area of Science:

• Rheumatology
• Health Services Research
• Patient-Reported Outcomes

Background:

• Treat-to-target (TTT) strategies are essential for managing rheumatoid arthritis (RA), requiring collaborative decisions between patients and rheumatologists on escalating care.
• Methotrexate monotherapy is a common initial treatment, but many patients require alternative or additional therapies.

Purpose of the Study:

• To develop preference phenotypes for patients with RA to aid shared decision-making when methotrexate monotherapy is insufficient.
• To understand patient priorities regarding different RA treatment options.

Main Methods:

• A conjoint analysis survey was used to assess patient preferences for triple therapy, biologics, and Janus kinase (JAK) inhibitors.
• Seven attributes were evaluated: administration, onset, bothersome side effects, serious infection risk, very rare side effects, information amount, and cost.
• Latent class analysis identified distinct preference phenotypes among 1273 RA patients.

Main Results:

• Five preference phenotypes were identified.
• The largest group (38.4%) prioritized medication cost, while another significant group (25.8%) focused on bothersome side effects.
• Other groups prioritized rare side effects, administration route (oral vs. parenteral), or a combination of onset and serious infection risk.

Conclusions:

• Patient preferences for RA treatments are measurable and can be categorized into distinct phenotypes.
• Recognizing this patient variability is vital for implementing effective shared decision-making within TTT approaches.