Bertrand Delphine, Deprez Anke, Doumen Michaël, De Cock Diederik, Pazmino Sofia, Marchal Anja, Thelissen Marc, Joly Johan, De Meyst Elias, Neerinckx Barbara, Westhovens René, Verschueren Patrick
Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium.
KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium.
Ther Adv Musculoskelet Dis. 2024 Feb 28;16:1759720X241232268. doi: 10.1177/1759720X241232268. eCollection 2024.
Several retreatment strategies exist for rituximab in rheumatoid arthritis (RA). In some countries, reimbursement criteria require a loss of disease control for rituximab retreatment. Understanding the patients' and rheumatologists' perceptions regarding this retreatment strategy would be informative in identifying the optimal treatment administration schedule.
This study aimed to uncover patients' and rheumatologists' perceptions regarding retreatment strategies of rituximab.
Qualitative study - semi-structured interviews.
Patients with RA, treated with rituximab, and rheumatologists were invited to participate in a qualitative study consisting of individual, in-depth, semi-structured interviews. Interviews were analysed according to the Qualitative Analysis Guide of Leuven.
A total of 16 patients and 13 rheumatologists were interviewed. Benefits (e.g. decreased risk of overtreatment, cost savings and long-lasting effectiveness of rituximab) and barriers (e.g. fluctuating disease activity, slow mode of action and increased glucocorticoid use) of on-flare retreatment were identified. To effectively treat on-flare, flares must first be identified timely. Both stakeholder groups acknowledged that patients are capable of recognizing flares. However, the patient's ability to discriminate between inflammatory and other types of pain was perceived as difficult. Furthermore, patients and rheumatologists stressed that patients must timely seek professional help in case of a flare, followed by a swift response from the rheumatologists. Remarkably, retreatment was approached in various ways among rheumatologists, and not always adhering strictly to the on-flare reimbursement criteria.
This study revealed that both stakeholder groups perceived the heterogeneity in recognition of and reaction to a flare as important in influencing the effectiveness of the on-flare retreatment strategy. Moreover, this study identified the benefits and barriers of treating on-flare, which could be informative for daily practice decisions.
类风湿关节炎（RA）中存在几种利妥昔单抗的再治疗策略。在一些国家，报销标准要求利妥昔单抗再治疗时疾病控制出现丧失。了解患者和风湿病学家对这种再治疗策略的看法，对于确定最佳治疗给药方案具有指导意义。
本研究旨在揭示患者和风湿病学家对利妥昔单抗再治疗策略的看法。
定性研究——半结构化访谈。
邀请接受过利妥昔单抗治疗的RA患者和风湿病学家参与一项定性研究，该研究包括个体深入的半结构化访谈。访谈依据鲁汶定性分析指南进行分析。
共访谈了16名患者和13名风湿病学家。确定了发作时再治疗的益处（如过度治疗风险降低、成本节约以及利妥昔单抗的长期有效性）和障碍（如疾病活动波动、作用方式缓慢以及糖皮质激素使用增加）。为有效治疗发作，必须首先及时识别发作。两个利益相关者群体都承认患者能够识别发作。然而，患者区分炎症性疼痛和其他类型疼痛的能力被认为有困难。此外，患者和风湿病学家强调，患者在发作时必须及时寻求专业帮助，随后风湿病学家要迅速做出反应。值得注意的是，风湿病学家采用了多种再治疗方式，并非总是严格遵循发作时的报销标准。
本研究表明，两个利益相关者群体都认为发作识别和反应的异质性对影响发作时再治疗策略的有效性很重要。此外，本研究确定了发作时治疗的益处和障碍，这对日常实践决策具有指导意义。
