LONDON – Patients with rheumatoid arthritis have high expectations of how effective biologic therapies will be in comparison to standard disease-modifying antirheumatic drugs, according to the results of a survey conducted in Japan.
RA patients taking biologics experience higher levels of anxiety than do patients taking DMARDs (66% vs. 53%) over switching treatments, and greater disappointment (37% vs. 28%) when therapies fail to live up to their expectations, according to Keiko Funahashi, a pharmacist from the Matsubara Mayflower Hospital and Research Institute of Joint Diseases, Kato City, Japan. She reported the results at the annual European Congress of Rheumatology.
Ms. Kate Llewelyn
RA treatment "has improved dramatically in the past 10 years. Due to the advent of biological products, patients’ treatment goals have also changed significantly," she added.
Indeed, the survey findings suggest that patients taking biologic agents are more likely to expect their treatment to eradicate joint pain and swelling rather than to just simply reduce it.
Ms. Funahashi and coauthor Dr. Tsukasa Matsubara, also of the Matsubara Mayflower Hospital and Research Institute of Joint Diseases, performed the outpatient survey in order to understand what patients expected of their treatment, and to determine the influence of biologic or nonbiologic DMARDs on patient attitudes.
The anonymous survey consisted of a short set of simple questions asking about the type of past and current treatment received, whether medications had been switched, what patients needed to know before starting a new treatment, their expectations of such treatment, and if they were satisfied with the results. Patients were also asked to state what their goals for treatment were.
A total of 165 patients attending the Matsubara Mayflower Hospital as outpatients during a 1-month period in October 2010 participated in the survey. In all, 110 patients were receiving treatment with DMARDs, and 55 were receiving biologics. Most patients were aged 50-70 years, and had a disease duration of 10-20 years.
While there was no significant difference between the DMARD and biologic treatment groups in terms of their current methotrexate use (70.7% vs. 63.6%, respectively), patients treated with biologic agents were less likely to be treated with steroids (40.8% vs. 21.8%, P less than .05) or nonsteroidal anti-inflammatory drugs (39.1% vs. 9.1%, P less than .01).
Before starting a new treatment, around 70% of patients in each group responded that they wanted to know about the side effects and efficacy first. Patients about to take biologics also wanted to know about the monthly cost, which they had to pay themselves, Ms. Funahashi said in an interview.
"Before treatment, patients taking biologics understood their disease better and had higher goals than those patients treated with DMARDs," Ms. Funahashi said. In particular, biologic-treated patients expected to see greater prevention of joint destruction, improved quality of life, and greater reductions in joint pain and swelling.
While patient goals hardly changed before and after treatment with DMARDs, the biologics group switched from not just wanting to reduce joint pain and swelling to wishing to eradicate them altogether.
The main cause of disappointment with treatment for patients treated with DMARDs was side effects, while a lack of efficacy was at the root of most patients’ dissatisfaction with biologic treatment.
"The results suggest that patients treated with biologics expect higher efficacy," Ms. Funahashi observed. This could be due to the perception that the higher cost equates with better efficacy. The cost of treatment is an important issue in Japan and a consideration when the rheumatologist and patient consider options.
The survey findings also highlight the need for good patient education and communication, and the development of realistic treatment goals.
"Doctors and health professionals really have a duty, I think, to give people the appropriate information, as well as do a lot of signposting to patient organizations and groups that can offer peer support," said Ms. Kate Llewelyn, who is head of information services at the U.K. charity Arthritis Care, in an interview.
"Learning to self-manage and realize that you can take control of your arthritis and rheumatism is one of the key things to feeling like you’re actually tackling the disease rather than being a passive recipient of treatment," Ms. Llewelyn suggested.
Ms. Funahashi, her coauthor Dr. Matsubara, and Ms. Llewelyn had no conflicts of interest to declare.