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Perspectives of Pediatric Rheumatologists on Initiating and Tapering Biologics in Patients with Juvenile Idiopathic
Gillian R Currie1,2,3,4, Tram Pham2, Marinka Twilt3,5,6
1Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Insights
Pediatric rheumatologists
Area of Science:
- Pediatric Rheumatology
- Qualitative Research
- Health Services Research
Background:
- Limited research exists on pediatric rheumatologists' decision-making processes for biologic therapies in juvenile idiopathic arthritis (JIA).
- This study aimed to understand treatment initiation and tapering strategies for biologics in JIA.
- It supported the development of a Best-Worst Scaling (BWS) survey for JIA treatment tapering.
Purpose of the Study:
- To describe pediatric rheumatologists' decision-making processes for initiating and tapering biologic treatments in JIA.
- To identify key attributes influencing these decisions for a BWS survey.
Main Methods:
- Qualitative interviews were conducted with pediatric rheumatologists across Canada until data saturation.
- Verbatim transcripts were analyzed using deductive thematic analysis.
- Attributes for the BWS survey were derived from interview themes and literature review.
Main Results:
- Five pediatric rheumatologists participated, reporting shared decision-making in biologic initiation and tapering.
- Tapering approaches varied, including immediate cessation or gradual dose reduction.
- Fourteen attributes were identified, encompassing patient factors (e.g., JIA subtype, remission status, disease severity) and contextual factors (e.g., biologic accessibility, willingness to taper).
Conclusions:
- This research addresses a gap in understanding biologic treatment decision-making for JIA.
- Identified attributes will inform a BWS survey to further explore decision-making importance.
- Future research should compare these attributes with patient and parent preferences.
Background:
Few studies have examined pediatric rheumatologists' approaches to treatment decision making for biologic therapy for patients with juvenile idiopathic arthritis (JIA). This study presents the qualitative research undertaken to support the development of a Best-Worst Scaling (BWS) survey for tapering in JIA. The study objectives were to (1) describe the treatment decision-making process of pediatric rheumatologists to initiate and taper biologics; and (2) select attributes for a BWS survey.
Methods:
Pediatric rheumatologists across Canada were recruited to participate in interviews using purposeful sampling. Interviews were conducted until saturation was achieved. Interview recordings were transcribed verbatim and transcripts were analyzed using deductive thematic analysis. Initial codes were organized into themes and subthemes using an iterative process. Attributes for the BWS survey were developed from these themes and a literature review was conducted in parallel to inform survey development. Further refinement of the attributes was done through consultation with the research team.
Results:
Five pediatric rheumatologists participated in the interviews. Shared decision making was part of the approach to initiating and tapering biologics in their practice. Tapering approaches differed; some pediatric rheumatologists preferred to stop biologics immediately, while others tapered by reducing dose and/or increasing the dose interval over time. A total of 14 attributes were developed for the BWS. Thirteen attributes were selected from the themes that emerged from the qualitative interviews and one attribute was included after review with the research team. Attributes related to patient characteristics included JIA subtype, time in remission, history or presence of joint damage or erosive disease, how challenging it was to achieve remission, and history of flares. Contextual attributes included accessibility of biologics and willingness to taper biologics.
Conclusion:
This study contributes to the limited literature on pediatric rheumatologists' approaches to treatment decision making for biologics in JIA and identifies attributes that affect the decision to both initiate and taper. Further research is planned to implement the BWS survey to understand the importance of the attributes identified. Additional investigation is required to determine if these characteristics align with patient and parent preferences.
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