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Patients' Perspectives Regarding Ankylosing Spondylitis Treatment Administration Features: Evidence from Qualitative
Atul Deodhar1, Martine C Maculaitis2, Lewis Kopenhafer3
1Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA.
Introduction:
Advanced therapies (ATs) for ankylosing spondylitis (AS) vary in processes related to treatment administration. We hypothesized that treatment preferences for patients with AS vary based on AT experience and disease status.
Methods:
This cross-sectional, mixed-methods study collected data from adults (aged ≥ 18 years) in the United States, United Kingdom, and Italy who had a confirmed AS diagnosis and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥ 4 and/or were currently taking AT. Burdensome aspects of AS and important AT administration attributes were identified in qualitative interviews with ten eligible patients. A cross-sectional online survey was also conducted, including a best-worst scaling (BWS) exercise with 12 treatment administration-related attributes and a series of six fixed-choice tasks, which presented two options varying only in mode and frequency of administration. Attribute relative importance was calculated from BWS data to sum to 100 across attributes. Frequencies and percentages were reported for fixed-choice tasks. Preferences from BWS data were compared by treatment/disease status (on AT/well controlled, on AT/not well controlled, not on AT/not well controlled) using one-way analysis of variance tests.
Results:
In qualitative interviews, patients reported pain (70.0%) and symptom unpredictability (50.0%) as the most bothersome aspects of AS. Overall, 210 patients (mean age 44.0 years) completed the survey; 37.6% were currently on AT. Patients not on AT/not well controlled preferred oral dosing, and patients on AT/well controlled preferred once-monthly injection and avoiding office/clinic visits; attribute relative importance estimates for patients currently on AT/not well controlled typically fell midway between the other groups. Most patients currently on AT/well controlled (range 78.6-100.0%) preferred injectable over oral options. Many on AT/not well controlled preferred once-daily pill over once-monthly (30.8%) or twice-monthly (40.0%) injections; once-monthly injection was preferred over oral options (range 60.0-69.2%). Many patients not currently on AT/not well controlled (range 50.4-68.7%) preferred oral over injectable options.
Conclusions:
Treatment preferences differed depending on whether AT was currently used and disease was well controlled. Findings enhance understanding of which patients may prefer different modes of AT administration.
