Patient satisfaction, preferences, expectations, characteristics, and impact of suboptimal control of rheumatoid arthritis: A subgroup analysis of Japanese patients from a large international cohort study (SENSE).

Yutaka Kawahito,Eiji Sugiyama,Akio Morinobu,Yuya Takakubo,Orsolya Nagy,Naoko Matsubara,Masataka Kuwana

doi:10.1371/journal.pone.0259389

Abstract

ObjectiveTo evaluate treatment satisfaction, disease outcomes, and perspectives of patients with poorly controlled rheumatoid arthritis (RA) treated with conventional synthetic, targeted synthetic, or biologic disease-modifying antirheumatic drugs (DMARDs), we conducted a subgroup (post hoc) analysis of Japanese patients participating in the SENSE study.MethodsData for Japanese patients (n/N = 118/1629) from the global, multicenter, cross-sectional, observational SENSE study were analyzed. The primary endpoint was the global satisfaction subscore assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4. Other patient-reported outcomes included self-reported RA medication adherence and Work Productivity and Activity Impairment-RA. Patient perspectives included patients’ expectations and preference of pharmacologic treatment.ResultsMedian (range) age and RA disease duration were 67.0 (18.0–87.0) years and 8 (0.0-54) years, respectively; 81.4% of patients were female. Mean (SD) TSQM global satisfaction subscore was 56.8 (17.5), and only 5.9% of patients reported good satisfaction with treatment (TSQM global ≥80). Mean (SD) self-reported treatment adherence using VAS was high (93.5% [13.8%]). Mean (SD) total work productivity impairment was 45.6% (32.0%); presenteeism contributed toward more total work productivity impairment (43.9% [30.4%]) than absenteeism (8.3% [24.4%]). Patients expected improvement in all parameters from their treatment, especially improvement in joint symptoms. Most patients (80.7%) preferred oral medication and 18.7% preferred monotherapy. Patient acceptability of potentially manageable side effects was high (7.5%-34.0%). Although most patients (81.3%) found combination therapy acceptable, 43.2% were receiving DMARD monotherapy.ConclusionAlthough most Japanese patients with RA with moderate-to-high disease activity were dissatisfied with their current DMARD treatment, high treatment adherence, high acceptability of combination therapy, high acceptability of manageable potential side effects, and preference for oral medication were reported. Data support the development of a more individualized and patient-centric approach for RA treatment.

Highlights

Rheumatoid arthritis (RA) is a global public health challenge with increasing prevalence and incidence rates worldwide [1] as well as a negative impact on patients’ quality of life and ability to work [2]
The estimated prevalence of RA in Japan ranges from 0.6% to 1.0% according to the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) registry [3]; the peak age at onset during 2012–2013 was between 60 and 69 years according to the National Database of Rheumatic Diseases by iR-net in Japan [4]
Suboptimal disease control in RA has a significant negative impact on patients’ treatment satisfaction, working life, patient-reported outcome (PRO), and patient perceptions. Results of this subgroup analysis of 118 Japanese patients who participated in the international, multicenter SENSE study [21] showed that this Japanese subpopulation with moderate-to-high disease activity has dissatisfaction of current treatment due to treatment effectiveness, but has high self-perceived treatment adherence, the highest level of acceptance relating to manageable side effects

Summary

Introduction

Rheumatoid arthritis (RA) is a global public health challenge with increasing prevalence and incidence rates worldwide [1] as well as a negative impact on patients’ quality of life and ability to work [2]. The estimated prevalence of RA in Japan ranges from 0.6% to 1.0% according to the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) registry [3]; the peak age at onset during 2012–2013 was between 60 and 69 years according to the National Database of Rheumatic Diseases by iR-net in Japan [4]. The evolution of the disease-modifying antirheumatic drugs (DMARDs) has provided wider treatment options for RA, including conventional synthetic DMARDs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs) [5]. Important differences in RA management have been noted in Japan compared with other countries. The immunosuppressant tacrolimus and csDMARDs (such as bucillamine and iguratimod) were developed in Japan. The use of tacrolimus is largely limited to Asia and Canada [9]

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Results

Discussion

Conclusion