Rheumatology Advance Access originally published online on November 3, 2006
Rheumatology 2006 45(12):1575-1576; doi:10.1093/rheumatology/kel369
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LETTERS TO THE EDITOR |
Patient preferences in choosing anti-TNF therapies-R1
Department of Rheumatology, Southampton University Hospitals NHS Trust, Southampton SO166YD, UK
Correspondence to: Dr E. Williams, BSc MRCP, Senior House Officer, Department of Rheumatology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. E-mail: emwilliams25{at}btinternet.co.uk
SIR, There are now three different anti-TNF agents licenced for use in patients with rheumatoid arthritis refractory to treatment with conventional DMARDs. Several other novel therapies including selective co-stimulation modulators (abatacept) [1], an antibody to IL-6 receptors (MRA), monoclonal antibodies against IL-15, and anti-CD20 antibodies (rituxumab) are being developed [2]. Preliminary data suggest that these other therapies may provide further alternatives to conventional DMARDs over the next few years [1, 2]. This plethora of different treatment options is welcome but may cause confusion when a choice of therapy is to be made.
The three currently licenced anti-TNF therapies appear to have largely similar efficacy in clinical practice, but vary in mode and frequency of administration. In this situation, the ultimate choice of which treatment to use may be determined by patient preference. Until now, there has been little data concerning which route of administration patients prefer. With increasing governmental and societal pressure to create a ‘patient-centred’ NHS, there has been a growing emphasis on involving patients in all decisions about their care. Indeed, this idea forms one of the cornerstones of the British Society for Rheumatology's (BSR) guidelines on standards of care for patients with rheumatoid arthritis [3]. With this in mind, we were keen to evaluate patient preferences for anti-TNF agents for rheumatoid arthritis.
We studied 100 consecutive patients with rheumatoid arthritis, who attended our rheumatology out-patient clinic in Southampton, UK, during 2004 [4]. Of these patients, 50 were currently receiving an anti-TNF therapy, whilst the remainder were on conventional DMARDs. Of those currently receiving anti-TNF therapy, the duration of treatment ranged from 1 to 45 months, with a mean duration of 18.4 months. Twelve of those in the group not yet on anti-TNF treatment were on our waiting list for anti-TNF therapy. To obtain the necessary data, a questionnaire was devised. This required patients to indicate their preferences regarding the route and frequency of administration of anti-TNF therapy. They were also asked in what environment they would prefer to be given treatment and who should be responsible for administering it. Finally, patients were asked to rank these four variables in order of importance. Of the 100 patients who participated in our study, 10 were excluded due to insufficient information on their questionnaires. The anti-TNF and non-anti-TNF groups were matched for age and gender, but differed slightly in terms of disease duration.
The route of administration was the single feature of anti-TNF therapy that concerned the patients most. Subcutaneous injection was the first choice preference for both those on anti-TNF therapy (41%) and those not yet receiving biological therapies (52.5%) (Table 1). In contrast, intravenous administration was preferred by 35% of those on anti-TNF but only 17.5% of those not yet receiving anti-TNF treatment. The remainder in each group indicated a preference for intramuscular administration (24% of those on anti-TNF; 30% of those not yet on anti-TNF therapy).
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The majority of patients in both groups indicated that they would rather receive treatment at home (62.5% of those on anti-TNF treatment; 52% not yet on anti-TNF therapy).
Not surprisingly, most individuals preferred the longest possible interval between doses.
As aforementioned, for those already receiving anti-TNF therapy, their over-riding concern was the route of administration. However, in both groups, a large number of individuals reported that the most important aspect of therapy was the environment in which treatment would be administered (14% of those not receiving anti-TNF therapy and 21% receiving anti-TNF therapy). The recent White Paper proposes the transfer of a significant proportion of specialist services, including rheumatology, back into the community [5]. Community-based infusion clinics run by specialist nurses and GPs in the primary care setting have been suggested. However, patient views from our study suggest a preference for hospital-based infusion centres. There is also evidence to suggest that the care of rheumatoid arthritis patients is not always adequate in the community, particularly with regard to the use of DMARDs [6].
In conclusion, both patient groups expressed a strong preference for receiving subcutaneous anti-TNF therapies at home, as infrequently as possible. However, it is equally important to note that the responses from those already on anti-TNF therapy concurred with both the route and frequency of treatment they were actually on, suggesting that they were happy with these aspects of their treatment [4]. This implies that patients were satisfied with the efficacy of all three anti-TNF therapies. It remains to be seen if the patterns of use of the different anti-TNF therapies will change once the proposed organizational reforms have been implemented. In turn, further studies will be required to determine whether any such changes will positively or negatively influence patient choice, satisfaction and compliance with anti-TNF therapy.
C.J.E. has received research support from Schering-Plough and Abbott Pharmaceuticals and has spoken at meetings organised by Schering-Plough, Abbott and Wyeth Pharmaceuticals. E.L.W. has declared no conflict of interest.
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References |
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 Top References |
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- Genovese MC, Becker JC, Schiff M, et al. (2005) Abatacept for rheumatoid arthritis refractory to TNF alpha inhibition. N Eng J Med 353:1114–23.
[Abstract/Free Full Text] - Voll RE and Kalden JR. (2005) Do we need new treatment that goes beyond TNF blockers for rheumatoid arthritis? Ann NY Acad Sci 1051:799–810.
[Abstract/Free Full Text] - Kennedy T, McCabe C, Struthers G, et al. (2005) BSR guidelines on standards of care for persons with rheumatoid arthritis. Rheumatology 44:553–6.
[Free Full Text] - Bennett SP, Sawyer S, Baker A, Arden NK, Edwards CJ. Patient preferences in choosing anti-TNF therapies. Abstract presented at BSR May 2005.
- Department of Health. Our health, our care, our say: a new direction for community services. White Paper, Department of Health 30/01/06 ISBN: 0101673728.
- Edwards CJ, Arden NK, Fisher D, et al. (2005) The changing use of disease-modifying anti-rheumatic drugs in individuals with rheumatoid arthritis from the United Kingdom General Practice Research Database. Rheumatology 44:1394–8.
[Abstract/Free Full Text]
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