Poudel Nabin, Qian Jingjing, Garza Kimberly B, Zeng Peng, Curtis Jeffrey R, Ngorsuraches Surachat
Department of Practice, Sciences, and Health Outcomes Research (P-SHOR), University of Maryland Baltimore, Baltimore, Maryland, USA.
Department of Health Outcomes Research and Policy, Auburn University, Harrison College of Pharmacy, Auburn, Alabama, USA.
Patient Prefer Adherence. 2025 Aug 4;19:2319-2331. doi: 10.2147/PPA.S514920. eCollection 2025.
The significance of fatigue reduction in rheumatoid arthritis (RA) is well recognized. However, prior patient preference studies on disease-modifying antirheumatic drugs (DMARDs) have not adequately explored the relative importance of fatigue reduction compared to other DMARD attributes or accounted for preference heterogeneity. The objective of this study is to determine the relative importance of DMARD attributes, including fatigue reduction, from the patient perspective.
We conducted a web-based discrete choice experiment (DCE) survey among RA patients in the US. Six DMARD attributes were included: chance of pain reduced by 50% or more, chance of physical function improved by 50% or more, chance of fatigue reduced by 10 points or more, chance of serious side effects, the route and frequency of administration, and out-of-pocket cost per month. Choice sets were constructed using a Bayesian efficient design. Mixed logit (ML) and latent class (LC) models were developed to determine preference weights and to calculate the conditional relative importance of each attribute.
Of 228 patients, the ML model showed that the chance of pain reduction had the highest conditional relative importance (2.4), followed by out-of-pocket cost (2.1), the chance of physical function improvement (1.6), the chance of fatigue reduction (1.5), the chance of experiencing serious adverse events (0.6), and the route and frequency of administration (0.09). Preference heterogeneity was observed. The LC model identified two patient classes. The chance of fatigue reduction and the out-of-pocket cost were the most important attributes for class 1 and class 2, respectively.
Pain reduction, physical function improvement, fatigue reduction, and out-of-pocket cost were relatively important DMARD attributes for RA patients. However, the presence of preference heterogeneity underscores the need for individualized treatment. Future studies should explore fatigue preferences and generalizability in the broader RA population.
类风湿关节炎（RA）中减轻疲劳的重要性已得到充分认可。然而，先前关于改善病情抗风湿药（DMARDs）的患者偏好研究并未充分探讨与其他DMARD属性相比减轻疲劳的相对重要性，也未考虑偏好异质性。本研究的目的是从患者角度确定DMARD属性（包括减轻疲劳）的相对重要性。
我们在美国的RA患者中进行了一项基于网络的离散选择实验（DCE）调查。纳入了六个DMARD属性：疼痛减轻50%或更多的几率、身体功能改善50%或更多的几率、疲劳减轻10分或更多的几率、严重副作用的几率、给药途径和频率以及每月自付费用。使用贝叶斯有效设计构建选择集。开发了混合逻辑（ML）模型和潜在类别（LC）模型来确定偏好权重并计算每个属性的条件相对重要性。
在228名患者中，ML模型显示疼痛减轻的几率具有最高的条件相对重要性（2.4），其次是自付费用（2.1）、身体功能改善的几率（1.6）、疲劳减轻的几率（1.5）、发生严重不良事件的几率（0.6）以及给药途径和频率（0.09）。观察到偏好异质性。LC模型识别出两类患者。疲劳减轻的几率和自付费用分别是第1类和第2类最重要的属性。
减轻疼痛、改善身体功能、减轻疲劳和自付费用是RA患者相对重要的DMARD属性。然而，偏好异质性的存在强调了个体化治疗的必要性。未来的研究应在更广泛的RA人群中探索疲劳偏好和普遍性。
