title: Openness to and preference for attributes of biologic therapy prior to initiation among patients with rheumatoid arthritis: patient and rheumatologist perspectives and implications for decision making.
abstract: OBJECTIVE
  Despite American College of Rheumatology recommendations, appropriate and timely initiation of biologic therapies does not always occur. This study examined openness to and preference for attributes of biologic therapies among patients with rheumatoid arthritis (RA), differences in patients' and rheumatologists' perceptions, and discussions around biologic therapy initiation.
  
  
  METHODS
  A self-administered online survey was completed by 243 adult patients with RA in the US who were taking disease-modifying antirheumatic drugs (DMARDs) and had never taken, but had discussed biologic therapy with a rheumatologist. Patients were recruited from a consumer panel (n=142) and patient advocacy organization (n=101). A separate survey was completed by 103 rheumatologists who treated at least 25 patients with RA per month with biologic therapy. Descriptive and bivariate analyses were conducted separately for patients and rheumatologists. Attributes of biologic therapy included route of administration (intravenous infusion or subcutaneous injection), frequency of injections/infusions, and duration of infusion.
  
  
  RESULTS
  Over half of patients (53.1%) were open to both intravenous infusion and subcutaneous injection, whereas rheumatologists reported 40.7% of patients would be open to both. Only 26.3% of patients strongly preferred subcutaneous injection, whereas rheumatologists reported 35.2%. Discrepancies were even more pronounced among specific patient types (eg, older vs younger patients and Medicare recipients). Among patients, 23% reported initiating discussion about biologics and 54% reported their rheumatologist initiated the discussion. A majority of rheumatologists reported discussing in detail several key aspects of biologics, whereas a minority of patients reported the same.
  
  
  CONCLUSIONS
  Preferences differed among patients with RA from rheumatologists' perceptions of these preferences for biologic therapy, including greater openness to intravenous infusion among patients than assumed by rheumatologists and relative lack of discussion about key aspects of biologic therapy perceived by patients. There is a need for more open communication about treatment options, which may encourage more appropriate, timely transition to biologic therapy.
authors.affiliation: Health Economics & Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Bolge
authors.affiliation: Health Outcomes Practice, Kantar Health, New York, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Goren
authors.affiliation: Health Outcomes Practice, Kantar Health, New York, USA.
authors.forename: Duncan
authors.initials: D
authors.lastname: Brown
authors.affiliation: Global Healthy Living Foundation, Upper Nyack, NY, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Ginsberg
authors.affiliation: Department of Biostatistics & Epidemiology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Allen
keywords: biologics; discussions about treatment; intravenous infusion; patient-provider communication; subcutaneous injection