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Patient preferences for disease modifying anti-rheumatic drug treatment in rheumatoid arthritis: A systematic review


Durand C1, Eldoma M1, Marshall DA1, Bansback N1, Hazlewood GS1. J Rheumatol. 2019 Apr 15. pii: jrheum.181165. doi: 10.3899/jrheum.181165. [Epub ahead of print]

Author Information

1 From the Department of Medicine and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Arthritis Research Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia. The work was supported in part by a Canadian Initiative for Outcomes in Rheumatology Care (CIORA) grant. Dr. Hazlewood is supported by a Canadian Institute of Health Research (CIHR) New Investigator Salary Award and The Arthritis Society Young Investigator Salary Award. Dr. Marshall is supported by a CIHR Canada Research Chair in Health Services and Systems Resea. Address correspondence to Dr. Glen Hazlewood, 3330 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4N1 Tel: (403) 220-5903, Fax: (403) 210-7367 Email: gshazlew@ucalgary.ca.



To summarize patients' preferences for disease modifying anti-rheumatic drug (DMARD) therapy in rheumatoid arthritis(RA).


We conducted a systematic review to identify English-language studies in adult RA patients that measured patients' preferences for DMARDs or health states and treatment outcomes relevant to DMARD decisions. Study quality was assessed using a published quality assessment tool. Data on the importance of treatment attributes and associations with patient characteristics was summarized across studies.


From 7951 abstracts, we included 36 studies from a variety of countries. Most studies were in patients with established RA and were rated as medium (n=19) or high quality (n=12). The methods to elicit preferences varied, with the most common being discrete choice experiment (DCE) (n=13). Despite the heterogeneity of attributes in DCE studies, treatment benefits (disease improvement) were usually more important than both non-serious (6 of 8 studies), and serious adverse events (5 of 8), and route of administration (7 of 9). Amongst the non-DCE studies, some found patients placed high importance on treatment benefits, while others (in patients with established RA) found patients were quite risk averse. Subcutaneous therapy was often, but not always preferred over intravenous therapy. Patient preferences were variable and commonly associated with sociodemographics.


Overall, the results showed that many patients place a high value on treatment benefits over other treatment attributes including serious or minor side effects, cost or route of administration. The variability in patient preferences highlights the need to individualize treatment choices in RA.