Singh Jasvinder A, Tornberg Haley, Goodman Susan M
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine.
Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA; Department of Medicine, Hospital for Special Surgery, 535 E 70th Street, New York city, NY 10021.
Joint Bone Spine. 2020 Jul;87(4):307-313. doi: 10.1016/j.jbspin.2020.02.009. Epub 2020 Mar 5.
To assess why patients choose TNF- versus non-TNF biologics for treating active rheumatoid arthritis (RA) after methotrexate-failure.
Participants responded to the question "What sort of things help a patient decide the treatment choice between the two types of injectable biologics, TNF biologic versus non-TNF biologic, for treating active rheumatoid arthritis when methotrexate fails to control RA disease activity?" They nominated responses, discussed and then voted.
Forty-four patients participated in 10 nominal groups (Birmingham; n=6; New York City: n=4), who were predominantly female (86%), 68% white, with a mean age of 65 (standard deviation [SD], 12) years. Present/past DMARDs included methotrexate in 91%, glucocorticoids in 11%, and biologics and/or Jak-inhibitors in 68% of participants. Pain and fatigue were mild-moderate with means of 3.9 (SD, 2.5) and 4.3 (SD, 2.5), respectively, on 0-10 scale; mean morning joint stiffness was 1.3hours (SD, 2.1). The number of groups that nominated each response and total votes were as follows: (1) Side effects/fear of side effects: 10/10; 31% votes (82/264); (2) Efficacy/ability to reduce joint damage: 9/10; 30% votes (80/264); (3) Doctor's opinion, 6/10; 12% votes (32/264); (4) Cost, 7/10; 9% votes (25/264); (5) Other drugs/comorbidity, 4/10; 12% votes (31/264); (6) Experience of others/information-seeking/own research, 2/10; 2% votes (5/264); (7) Newness, 1/10; 2% votes (6/264); and (8) Convenience/frequency of use, 1/10; 1% votes (3/264).
We identified the patient perspective of choice between TNF versus non-TNF biologic for treating active RA. This knowledge can help in informative shared decision-making in clinical care.
评估在甲氨蝶呤治疗失败后，患者选择肿瘤坏死因子（TNF）生物制剂而非非TNF生物制剂治疗活动性类风湿关节炎（RA）的原因。
参与者回答问题“当甲氨蝶呤无法控制RA疾病活动时，对于治疗活动性类风湿关节炎，哪些因素有助于患者在两种注射用生物制剂（TNF生物制剂和非TNF生物制剂）之间做出治疗选择？”他们提出回答，进行讨论，然后投票。
44名患者参与了10个名义小组（伯明翰；n = 6；纽约市：n = 4），其中大多数为女性（86%），68%为白人，平均年龄为65岁（标准差[SD]，12）。目前/过去使用的改善病情抗风湿药（DMARDs）包括91%的患者使用过甲氨蝶呤，11%使用过糖皮质激素，68%使用过生物制剂和/或JAK抑制剂。疼痛和疲劳为轻度至中度，在0-10分的量表上，平均值分别为3.9（SD，2.5）和4.3（SD，2.5）；平均晨僵时间为1.3小时（SD，2.1）。每个回答被提名的小组数量和总票数如下：（1）副作用/对副作用的恐惧：10/10；31%的票数（82/264）；（2）疗效/减少关节损伤的能力：9/10；30%的票数（80/264）；（3）医生的意见，6/10；12%的票数（32/264）；（4）费用，7/10；9%的票数（25/264）；（5）其他药物/合并症，4/10；12%的票数（31/264）；（6）他人的经验/信息寻求/自身研究，2/10；2%的票数（5/264）；（7）新颖性，1/10；2%的票数（6/264）；（8）便利性/使用频率，1/10；1%的票数（3/264）。
我们确定了患者在选择TNF生物制剂和非TNF生物制剂治疗活动性RA时的观点。这些信息有助于在临床护理中进行信息充分的共同决策。
