Dose reduction of biologic therapy in inflammatory arthritis: A qualitative study of patients' perceptions and needs

Hewlett, Sarah; Haig-Ferguson, Andrew; Rose-Parfitt, Emily; Halls, Serena; Freke, Samuel; Creamer, Paul

Abstract

© 2018 John Wiley & Sons, Ltd. Objective: Successful biologic disease-modifying anti-rheumatic drug (bDMARD) dose reduction appears increasingly possible from clinical trials. The present study aimed to understand the patient perspective of bDMARD dose reduction. Methods: Patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis who were self-administering subcutaneous bDMARDs therapy at two National Health Service trusts participated in semi-structured interviews. To capture multiple experiences, patients were purposefully sampled for a range of age, gender, disease duration, reducing/not reducing bDMARDs and either within 3–12months of bDMARD initiation or ≥12months and in remission/low disease activity. Inductive thematic analysis was utilized. Results: Fifteen patients were interviewed (six on dose reduction). Five overarching themes were identified. When thinking about dose reduction, patients reflected on their difficult life before bDMARDs (“Where I was then”) compared with their transformative effects (“Where I am now”). All raised concerns that a dose reduction would take them back to where they used to be (“Fears for the future”) and most believed it to be a cost-cutting exercise. Most had “Hopes for the future”, that a reduction would lower their risk of side effects, and release funds for other patients. They wanted a clear rationale for reduction, collaborative decision making, and control over flexible dosing (“Information needs”). Conclusion: Patients were fearful of reducing the dose of their bDMARDs, having previously experienced uncontrollable symptoms. However, most were willing to try, provided that there was a clear rationale and that it was in their best interests, with opportunities for collaboration and dose control. These patient perspectives will inform the provision of patient information to guide clinical discussions.

• Journal Article Type: Article
• Acceptance Date: Sep 5, 2018
• Online Publication Date: Nov 6, 2018
• Publication Date: Mar 1, 2019
• Deposit Date: Oct 10, 2018
• Publicly Available Date: Nov 7, 2019
• Journal: Musculoskeletal Care
• Print ISSN: 1478-2189
• Electronic ISSN: 1557-0681
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 1
• Pages: 63-71
• DOI: https://doi.org/10.1002/msc.1367
• Public URL: https://uwe-repository.worktribe.com/output/849787
• Publisher URL: https://doi.org/10.1002/msc.1367
• Additional Information: Additional Information : This is the peer reviewed version of the following article: [Hewlett, S., Haig-Ferguson, A., Rose-Parfitt, E., Halls, S., Freke, S. and Creamer, P. (2018) Dose reduction of biologic therapy in inflammatory arthritis: a qualitative study of patients’ perceptions and needs. Musculoskeletal Care. ISSN 1478-2189], which has been published in final form at https://doi.org/10.1002/msc.1367. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Contract Date: Oct 10, 2018