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
Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.
Department of Public Health and Primary Care, Environment and Health, KU Leuven, Leuven, Belgium.
Musculoskeletal Care. 2024 Jun;22(2):e1893. doi: 10.1002/msc.1893.
The recommended dose of a rituximab course for the treatment of Rheumatoid Arthritis (RA) consists of two infusions of 1000 mg with a 2-week interval. Evidence is growing that a lower dose could be as effective. We aimed to investigate patients' and rheumatologists' perceptions on dose reduction of rituximab.
Patients with RA treated with rituximab, and rheumatologists were invited for a qualitative study via individual semi-structured interviews. Participants were recruited based on purposive sampling to ensure diversity. Interviews were analysed according to the principles of grounded theory and the constant comparative method.
Sixteen patients and 13 rheumatologists were interviewed. Patients and rheumatologists perceived the benefits of rituximab dose reduction for reasons of safety and societal costs. Furthermore, available evidence for the effectiveness of lower doses was mentioned as an argument in favour, in addition to the possibility to tailor the dose based on the patients' clinical manifestations. However, patients and rheumatologists had concerns about the potential loss of effectiveness and quality of life. Moreover, some rheumatologists felt uncomfortable with dose reduction due to insufficient experience with rituximab in general. Patients and rheumatologists emphasised the importance of shared decision-making, underscoring the pivotal role of physicians in this process by explaining the reasoning behind dose reduction.
Although some concerns on effectiveness were perceived, both patients and rheumatologists saw potential benefits of dose reduction in terms of safety, societal costs, and application of a personalised approach. As a result, most rheumatologists and patients showed a willingness to consider dose reduction strategies.
治疗类风湿关节炎（RA）时，利妥昔单抗一个疗程的推荐剂量为两次输注，每次1000毫克，间隔2周。越来越多的证据表明，较低剂量可能同样有效。我们旨在调查患者和风湿病学家对利妥昔单抗剂量降低的看法。
邀请接受利妥昔单抗治疗的RA患者和风湿病学家参与一项定性研究，采用个体半结构式访谈。基于目的抽样招募参与者以确保多样性。根据扎根理论原则和持续比较法对访谈进行分析。
对16名患者和13名风湿病学家进行了访谈。患者和风湿病学家认为，出于安全性和社会成本的考虑，降低利妥昔单抗剂量有好处。此外，除了根据患者临床表现调整剂量的可能性外，较低剂量有效性的现有证据也被作为支持理由提及。然而，患者和风湿病学家担心有效性和生活质量可能会下降。此外，一些风湿病学家因总体上对利妥昔单抗经验不足，对降低剂量感到不安。患者和风湿病学家强调了共同决策的重要性，强调医生在这一过程中的关键作用，即解释降低剂量背后的理由。
尽管人们察觉到了对有效性的一些担忧，但患者和风湿病学家都认为，在安全性、社会成本和个性化方法应用方面，降低剂量有潜在益处。因此，大多数风湿病学家和患者都表示愿意考虑降低剂量策略。
