Preferences for Biologic Treatment in Patients With Psoriatic Arthritis: A Discrete Choice Experiment.

Abstract

We aimed to assess patient preferences for the characteristics and outcomes of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) to manage psoriatic arthritis. We conducted a discrete choice experiment in patients with psoriatic arthritis from 3 rheumatology centers in Sydney, Australia. We assessed preferences for different attributes of biologic medications. The route and frequency of medications had a range of 5 levels, and the following 7 attributes had a range of 3 levels: the ability to attend to normal activities, improvements in joint pain, enthesitis and skin disease, chance of disease remission, risk of infection, and risk of severe adverse events. Multinomial logit models including a latent class model were used to calculate preferences. Of the 150 participants, 58.3% were female, with a median age of 53.5 years. The attributes in order of preference using the β coefficient in absolute values (95% confidence interval [95% CI]) were as follows: oral route compared to subcutaneous and intravenous routes (β coefficient 1.00 [fixed parameter]), avoiding severe side effects (β coefficient 0.72 [95% CI 0.50, 0.95]), increasing ability to attend to normal activities (β coefficient 0.66 [95% CI 0.36, 0.96]), avoiding infections (β coefficient 0.38 [95% CI 0.23, 0.53]), improvement in enthesitis pain (β coefficient 0.28 [95% CI 0.20, 0.36]), improvement in psoriasis (β coefficient 0.28 [95% CI 0.20, 0.36]), increasing chance of remission (β coefficient 0.27 [95% CI 0.19, 0.36]), and improvement in joint pain (β coefficient 0.26 [95% CI 0.00, 0.52]). When choosing biologic medications, patients with psoriatic arthritis preferred oral medications. Patients prioritized avoiding severe complications, maintaining the ability to attend to work and normal activities, and avoiding infection over clinical measures of efficacy.