Route of Administration a Key Treatment Component for Rheumatoid Arthritis Patients

Commercially insured rheumatoid arthritis (RA) patients believe the route of administration is the most important individual attribute regarding their treatment.

In a study published in American Health & Drug Benefits, researchers conducted a conjoint analysis to determine the relative importance of individual drug attributes, including safety, efficacy, and the mode, method, and frequency of administration to determine RA patient preferences for specific therapies.

There were 1400 commercially insured RA patients between the ages of 21 to 80-years-old, who were randomly selected and mailed a choice-based conjoint survey.

To be eligible, patients were required to be continuously enrolled in a fully insured Humana commercial health plan with medical and pharmacy benefits from May 1, 2012 through April 30, 2013.

Participants were also required to have had ≥2 medical claims in the previous 12 months that were at least 30 days apart for International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 714.0, as well as no prior use of a biologic disease-modifying antirheumatic drug (DMARD).

The treatment attributes included in the study were frequency of administration, monthly out-of-pocket cost, route of administration, ability to reduce daily joint pain and swelling, the likelihood of serious adverse events (AEs), improvement in the ability to perform daily tasks, and medication burden.

Researchers used a hierarchical Bayes model to adjust for patient demographics before calculating the mean attribute importance scores, which ranked patient preferences for each treatment.

Part-worth utility data was used to perform a conjoint market simulation that predicts the share of preference for the oral Janus kinase inhibitor tofacitinib and for biologic DMARDs.

There was a 27.1% response rate among a total of 380 patients who returned the survey. The average age of respondents was 54.9 (standard deviation [SD], 9.3) years and a majority of participants were female (81.6%).

The nonrespondents were found to be 2 years younger with a mean of 52.9 years. However, this did not differ significantly from respondents in known clinical characteristics.

The results of the study showed that overall, from highest to lowest, the relative importance of attributes for respondents was the route of administration (34.1 ± 15.5), frequency of administration (16.4 ± 6.8), serious adverse events (12.0 ± 9.3), cost (10.1 ± 6.2), medication burden (9.8 ± 8.2), joint pain reduction (8.9 ± 3.8), and improvement in daily tasks and activities (8.8 ± 4.7).

The part-worth utility for the route of administration attribute was found to be highest for the oral route. The conjoint simulation results revealed that 56.4% of respondents prefer oral administration.

The survey’s findings suggest that commercially insured RA patients consider the route of administration to be an important attribute for their RA treatment. Additionally, study authors believe that understanding patient preferences can help inform both provider and payer in selecting a treatment option and could enhance a patient’s adherence.