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Benefit-risk trade-offs for treatment decisions in moderate-to-severe rheumatoid arthritis: focus on the patient perspective

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Abstract

Given the increasing number of available treatments for rheumatoid arthritis (RA) with varying efficacy and safety profiles, it is critical to understand the level of trade-offs that patients are willing to make between benefits and risks. Adult patients with moderate to severe RA were invited to participate in a discrete choice experiment that solicited their preferences for hypothetical RA treatments. Each participant was presented with 14 choice cards asking about their preference between two hypothetical RA treatments with varying levels of efficacy, adverse events, and process-related attributes. A multivariable logistic regression model assessed the association between the attributes and the patient’s decision and risk-increases were calculated. 510 eligible patients with moderate to severe RA completed the study. The average age of the participants was 56.4 years, 64.7% were female, and 45.1% received biologic agents. To achieve a 50% improvement in physical function, patients were willing to accept risk-increases of 91.1, 4.7, and 18.4% for abnormal laboratory results, cancer, and serious infection, respectively. Similarly, to achieve a 50% reduction in RA-related pain, patients were willing to accept risk-increases of 70.6, 3.7, and 14.2% for each AE. Moreover, patients were willing to trade risk-increases of 42.0, 2.2, and 8.5% for each AE to obtain a 50% reduction in the number of swollen joints. Patients with moderate to severe RA are willing to accept increased treatment risks to achieve improved physical function and disease control. These attributes are helpful to clinicians to make informed treatment choices.

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Acknowledgements

The authors would like to thank Cheryl Q. Xiang and Giuliana Zaccardelli from Analysis Group for significant contribution towards medical writing and analytical support. Financial support for these services was provided by AbbVie.

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Authors and Affiliations

  1. Cleveland Clinic, Cleveland, OH, USA

    M. Elaine Husni

  2. Analysis Group, Inc., 333 S. Hope Street, 27th Floor, Los Angeles, CA, USA

    Keith A. Betts

  3. AbbVie Inc., North Chicago, IL, USA

    Jenny Griffith & Arijit Ganguli

  4. Analysis Group, Inc., Boston, MA, USA

    Yan Song

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Correspondence to Keith A. Betts.

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Conflict of interest

Dr. M. Elaine Husni has served as a consultant to AbbVie and on advisory boards for AbbVie, Bristol-Meyers Squibb, Genentech, Novartis, Pfizer, and Janssen. Keith A. Betts and Yan Song have served as consultants to AbbVie. Jenny Griffith and Arijit Ganguli are employees of AbbVie and may own company stock.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Design, conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract. All authors contributed to the development of the publication and maintained control over the final content.

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Husni, M.E., Betts, K.A., Griffith, J. et al. Benefit-risk trade-offs for treatment decisions in moderate-to-severe rheumatoid arthritis: focus on the patient perspective. Rheumatol Int 37, 1423–1434 (2017). https://doi.org/10.1007/s00296-017-3760-z

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