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Preventing rheumatoid arthritis: Preferences for and predicted uptake of preventive treatments among high risk individuals

Author

Harrison M1,2,3, Spooner L1, Bansback N2,3,4, Milbers K2, Koehn C5, Shojania K3,6, Finckh A7, Hudson M8. PLoS One. 2019 Apr 25;14(4):e0216075. doi: 10.1371/journal.pone.0216075. eCollection 2019.

Author Information

1 Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.

2 Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.

3 Arthritis Research Canada, Richmond, Canada.

4 School of Population and Public Health, University of British Columbia, Vancouver, Canada.

5 Arthritis Consumer Experts/JointHealth, Vancouver, Canada.

6Division of Rheumatology, University of British Columbia, Vancouver, Canada.

7 Division of Rheumatology, University of Geneva, Geneva, Switzerland.

8 Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, and Department of Medicine, McGill University, Montreal, Canada.

Abstract

OBJECTIVE: 

To understand preferences for and estimate the likely uptake of preventive treatments currently being evaluated in randomized controlled trials with individuals at increased risk of developing rheumatoid arthritis (RA).

METHODS: 

Focus groups were used to identify key attributes of potential preventive treatment for RA (reduction in risk of RA, how treatment is taken, chance of side effects, certainty in estimates, health care providers opinion). A web-based discrete choice experiment (DCE) was administered to people at-risk of developing RA, asking them to first choose their preferred of two hypothetical preventive RA treatments, and then between their preferred treatment and 'no treatment for now.' DCE data was analyzed using conditional logit regression to estimate the significance and relative importance of attributes in influencing preferences.

RESULTS: 

Two-hundred and eighty-eight first-degree relatives (60% female; 66% aged 18-39 years) completed all tasks in the survey. Fourteen out of fifteen attribute levels significantly influenced preferences for treatments. How treatment is taken (oral vs. infusion β0.983, p<0.001), increasing reduction in risk of RA (β0.922, p<0.001), health care professional preference (β0.900, p<0.001), and avoiding irreversible (β0.839, p<0.001) or reversible serious side effects (β0.799, p<0.001) were most influential. Predicted uptake was high for non-biologic drugs (e.g. 84% hydroxycholoroquine), but very low for atorvastatin (8%) and biologics (<6%).

CONCLUSION: 

Decisions to take preventative treatments are complex, and uptake depends on how treatments can compromise on convenience, potential risks and benefits, and recommendations/preferences of health care professionals. This evidence contributes to understanding whether different preventative treatment strategies are likely to be acceptable to target populations.