Preventing rheumatoid arthritis: Preferences for and predicted uptake of preventive treatments among high risk individuals.

Mark Harrison,Axel Finckh,Kam Shojania,Marie Hudson,Nick Bansback,Katherine Milbers,Luke Spooner,Cheryl Koehn

doi:10.1371/journal.pone.0216075

Abstract

ObjectiveTo understand preferences for and estimate the likely uptake of preventive treatments currently being evaluated in randomized controlled trials with individuals at increased risk of developing rheumatoid arthritis (RA).MethodsFocus groups were used to identify key attributes of potential preventive treatment for RA (reduction in risk of RA, how treatment is taken, chance of side effects, certainty in estimates, health care providers opinion). A web-based discrete choice experiment (DCE) was administered to people at-risk of developing RA, asking them to first choose their preferred of two hypothetical preventive RA treatments, and then between their preferred treatment and ‘no treatment for now.’ DCE data was analyzed using conditional logit regression to estimate the significance and relative importance of attributes in influencing preferences.ResultsTwo-hundred and eighty-eight first-degree relatives (60% female; 66% aged 18–39 years) completed all tasks in the survey. Fourteen out of fifteen attribute levels significantly influenced preferences for treatments. How treatment is taken (oral vs. infusion β0.983, p<0.001), increasing reduction in risk of RA (β0.922, p<0.001), health care professional preference (β0.900, p<0.001), and avoiding irreversible (β0.839, p<0.001) or reversible serious side effects (β0.799, p<0.001) were most influential. Predicted uptake was high for non-biologic drugs (e.g. 84% hydroxycholoroquine), but very low for atorvastatin (8%) and biologics (<6%).ConclusionDecisions to take preventative treatments are complex, and uptake depends on how treatments can compromise on convenience, potential risks and benefits, and recommendations/preferences of health care professionals. This evidence contributes to understanding whether different preventative treatment strategies are likely to be acceptable to target populations.

Highlights

Decisions to take preventative treatments are complex, and uptake depends on how treatments can compromise on convenience, potential risks and benefits, and recommendations/preferences of health care professionals
This evidence contributes to understanding whether different preventative treatment strategies are likely to be acceptable to target populations
Rheumatoid arthritis (RA) is thought to develop through “multiple hits”,[1] with genetic and environmental risk factors,[2] followed by antibodies such as rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA),[3,4,5] that accumulate during an “at-risk” pre-clinical phase

Summary

Introduction

Rheumatoid arthritis (RA) is thought to develop through “multiple hits”,[1] with genetic and environmental risk factors,[2] followed by antibodies such as rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA),[3,4,5] that accumulate during an “at-risk” pre-clinical phase. This pre-clinical phase lasts 3–5 years before culminating in clinical disease and can be described in five phases.[6,7,8,9] Asymptomatic phases (A-C) depend on whether individuals have genetic (Phase A) or environmental (Phase B) risk factors, or systemic autoimmunity associated with RA (Phase C). It is thought these pre-clinical phases offer a window of opportunity for potential preventive treatment.[10]

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Conclusion