Objectives
Tapering of biologics is a safe and feasible approach in the long-term management of rheumatoid arthritis (RA) patients who are in remission. However, the appeal of tapering strategies needs to be balanced against the risks of disrupting patients’ disease control. The aim of this study was to measure the preferences of RA patients and their risk-benefit trade-offs in relation to biologic tapering.
Methods
A web-based discrete choice experiment (DCE) was employed. Seven attributes (identified via focus groups and a systematic review) of varying levels describing three hypothetical choice were presented: frequency of treatment, chances of known adverse effects, chances of regaining disease control and healthcare service-related features. DCE data were analysed using mixed logit model to estimate the preference weights for key treatment features and to quantify trade-offs between the attributes.
Results
A total of 142 complete responses were analysed. Mean age was 60.3 years with an average disease duration of 20.8 years Frequency of biologic treatment was the most important attribute, followed by the chance of flare upon tapering. Time to see the rheumatology team after a flare was ranked the least important among the seven attributes. On average, participants were willing to accept between 25.3% to 50.2% increase in chance of disease flare in exchange for reducing the frequency of biologic treatment, chance of serious infection and chance of skin cancer.
Conclusions
This study provides evidence that RA patients’ preference for tapering biologics are most influenced by the frequency of treatment and chance of flare. For these attributes, they are willing to accept a greater chance of flare in exchange for treatment benefits in the form of a reduction in biologic dosing and potential risk of serious infection and skin cancer associated with long-term biologic use. These findings have implications for clinical practice and policy making about tapering.
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