Professed patient satisfaction with their current rheumatoid arthritis therapy had less to do with actual therapeutic success than the fact that their disease did not worsen while on a given treatment, according to the findings of a large survey.
In their survey of 6,135 rheumatoid arthritis (RA) patients in the United States, Dr. Frederick Wolfe and Kaleb Michaud, Ph.D., both of the National Data Bank for Rheumatic Disease, in Wichita, Kan., found that overall, 66% of patients did not think there was a better treatment than what they were currently receiving; of those patients not receiving biologic agents (part of the recommended aggressive multidrug therapy for optimal RA treatment), the number was 58%.
The survey, conducted in January 2006, involved a 28-page questionnaire that assessed sociodemographic data as well as disease severity, disease duration, and past and present RA treatment. Median participant age was 62.7 years; median RA duration was 15 years. Nearly 80% were female.
Overall, roughly 64% said they would not want to change therapy unless their condition worsened. Of those, 87% cited a fear of side effects as a reason why they wouldn't switch therapies; fear of losing control if the new treatments didn't work was cited by 81%; and the belief that there were no better drugs for their disease was given by 76% of patients. The roughly two-thirds of patients who reported side effects to an arthritis drug at some point in their lifetime were least likely to be willing to change therapy (OR 1.8) and most likely to be concerned about the risk of side effects with a therapy switch (OR 1.2).
Despite patients' professed unwillingness to switch, 71% of patients who said they were satisfied with their treatment had moderate or greater arthritis activity on the Patient Activity Score, and 47% had Health Assessment Questionnaire scores greater than 1.0, which correlates with a severe disease rating, they reported (Arthritis Rheum. 2007;56:2135-42).
“Given relatively stable RA and prior experience with RA treatments, maintenance of current status [not getting worse] appears to be given high priority by patients,” wrote the investigators. They added that although cost of new drugs, inconvenience, and potential administrative hassles with their insurance carrier also contributed to patients' unwillingness to try potentially better, new therapies, “they played a small role in thinking about therapies,” compared with fear of side effects and fear of losing control, which led patients with even severe disease to resist switching therapies. “Patients' reluctance [to change therapy] may contain wisdom about homeostasis that goes beyond the experimentation of clinical trials and that is based on experience and preferences for the future. The idea of 'not getting worse' may be an important outcome that has not been considered sufficiently in therapeutic decision making.”
Dr. Wolfe acknowledged that the National Data Bank, a nonprofit research data bank, has received pharmaceutical support in the past, but the current study was independent.