De Mits Sophie, Lenaerts Jan, Vander Cruyssen Bert, Mielants Herman, Westhovens René, Durez Patrick, Elewaut Dirk
Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
Department of Rheumatology, Reuma-Instituut Hasselt, Leuven University Hospital, Leuven, Belgium.
PLoS One. 2016 Nov 28;11(11):e0166607. doi: 10.1371/journal.pone.0166607. eCollection 2016.
Biological treatment of rheumatoid arthritis (RA) is one of the cornerstones of current treatment strategies for the disease. Surprisingly little information exists on whether the route of administration affects patients' treatment satisfaction. It is equally unclear whether rheumatologists are able to accurately perceive their patients' appreciation. Thus, the Belgian Be-raise survey aimed to examine whether RA patient's experience of their current biological treatment coincided with the treating physician's perception.
A nationwide cross-sectional survey was conducted by 67 Belgian rheumatologists providing data obtained from 550 RA patients. Patients under stable dose of biologics for at least 6 months, were enrolled consecutively and all completed questionnaires. Separate questionnaires were completed by the treating rheumatologist which evaluated their patient's perception of the route of treatment administration. This study therefore evaluates whether a treating physician perceives the satisfaction with the route of administration to the same degree as the patient.
Completed questionnaires were obtained from 293 and 257 patients who obtained treatment via the intravenous (IV) or subcutaneous (SC) route of administration, respectively. 58.4% of patients were in DAS28-CRP(3) remission. Patient satisfaction with disease control was higher (44% scored ≥ 9) than that of the treating physician (35%), regardless of the route of administration (p< 0.01). No differences were seen for the patients treated with an IV as opposed to a SC route of administration. The physician´s perception of patient's satisfaction with disease control was markedly lower for IV treated patients as opposed to SC treated patients (p< 0.001).
Patients' satisfaction with biological treatment is high, but there is a considerable mismatch between patients´ and rheumatologists´ appreciation on the route of administration of biological therapy in RA. Physicians consistently consider IV biological therapy to be less satisfactory. Patient´s appreciation is largely dependent on disease control, irrespective of the route of administration. Therefore, and encouraging shared decision making, we suggest that physicians and patients discuss the route of administration of biologicals in an open way.
类风湿关节炎（RA）的生物治疗是当前该疾病治疗策略的基石之一。令人惊讶的是，关于给药途径是否会影响患者的治疗满意度，现有信息极少。同样不清楚的是，风湿病学家是否能够准确感知患者的满意度。因此，比利时的Be-raise调查旨在研究RA患者对当前生物治疗的体验与治疗医生的认知是否一致。
67位比利时风湿病学家开展了一项全国性横断面调查，提供了从550例RA患者那里获得的数据。连续纳入至少6个月使用稳定剂量生物制剂的患者，所有患者均完成问卷。治疗的风湿病学家单独完成问卷，评估他们对患者治疗给药途径的认知。因此，本研究评估治疗医生对给药途径的满意度认知与患者是否相同。
分别从通过静脉注射（IV）或皮下注射（SC）途径接受治疗的293例和257例患者那里获得了完整问卷。58.4%的患者处于DAS28-CRP（3）缓解状态。无论给药途径如何，患者对疾病控制的满意度更高（44%评分≥9），高于治疗医生（35%）（p<0.01）。静脉注射与皮下注射给药途径的患者之间未见差异。与皮下注射治疗的患者相比，静脉注射治疗的患者，医生对其疾病控制满意度的认知明显更低（p<0.001）。
患者对生物治疗的满意度较高，但在RA生物治疗的给药途径方面，患者和风湿病学家的认知存在相当大的差异。医生一直认为静脉注射生物治疗不太令人满意。患者的满意度很大程度上取决于疾病控制，与给药途径无关。因此，为鼓励共同决策，我们建议医生和患者以开放的方式讨论生物制剂的给药途径。
