Treatment Satisfaction and Decision‐making from the Patient Perspective in Axial Spondyloarthritis: Real‐World Data from a Descriptive Cross‐sectional Survey Study from the ArthritisPower Registry

Abstract

Objective. Aims were to 1) to characterize patient decision-making with treatment for axial spondyloarthritis (axSpA) and 2) to explore relationships among decision-making, treatment satisfaction, and biologic disease modifying antirheumatic drugs (bDMARDs).Methods. ArthritisPower participants with physician-diagnosed axSpA were invited to complete an online survey about their treatment and their most recent physician visit. Analysis compared treatment decision by satisfaction and bDMARD status.Results. Among the 274 participants, 87.2% were female, and the mean age was 50 years. Of participants, 79.5% had researched treatment before their most recent physician visit, and 56.9% discussed treatment change at their most recent physician visit. Of treatment-change discussions, 69.2% of them were related to escalation, compared with deescalation (27.6%) and/or switching (39.1%). Among those participants who discussed a change, 73.7% agreed to it because they felt that their disease was not being controlled (54.9%) or felt that it could be better controlled on new treatment (20.3%). Top symptoms prompting change were back/buttock pain (63.3%), other joint pain (55.1%), and fatigue (54.1%). Among bDMARD-treated participants (n = 128), important factors for treatment decisions were prevention of long-term axSpA consequences (92.9%) and doctor's advice (87.5%). Among 43.4% of participants reporting treatment dissatisfaction, 37% did not discuss treatment change. Current bDMARD use was more common in satisfied (61.9%) than dissatisfied participants (26.9%).Conclusion. In this cross-sectional study of a predominantly female axSpA population, patients frequently researched treatment options and discussed escalation with their providers. Under two-thirds of participants who were dissatisfied with treatment discussed changes at their most recent visit. Current bDMARD use was associated with higher satisfaction, and bDMARD users considered prevention of long-term consequences and doctor's advice to be very important for decision-making.

Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials

“…starting in patients' mid-20s, 5 axSpA has a significant and lasting impact on patient lives [6][7][8] and a high disease burden. 3 Many patients with axSpA fail treatment, do not achieve treatment targets or experience residual symptoms, [9][10][11] demonstrating the need for more treatment options with novel modes of action. Interleukin (IL)-17A and IL-17F are key mediators of inflammation.…”

Elevating the Standard of Care for Patients with Axial Spondyloarthritis: ‘Calls to Action’ from Rheumacensus, a Multistakeholder Pan-European Initiative

“…Several barriers to optimal care exist e.g. identification and timely referral of patients with axSpA [3,6,7]. Lack of axSpA awareness and knowledge, coupled with the insidious onset of symptoms may contribute to these barriers [6][7][8].…”

“…Disparities exist around treatment goals of HCPs and patients, causing patients to feel unsupported and undervalued [1,2]. However, in recent years a shift towards patient-centred care is advocating for patient involvement in shared decision-making (SDM) [5,7,13,15]. Inadequate insurance coverage, lack of awareness around treatment options and limited patient education on treatment (e.g.…”

“…Inadequate insurance coverage, lack of awareness around treatment options and limited patient education on treatment (e.g. risks and benefits) also limit care [7]. Therefore, a holistic approach between HCPs, payors and patients is essential to promote patient empowerment and elevate health outcomes [1,2,5,13,15].…”

Patient Perspectives on Biologics for Axial Spondyloarthritis in a Cross-sectional Study in a Predominantly Female Population: Treatment Satisfaction, Wear-off Between Doses, and Use of Supplemental Medication

“…To achieve these desired outcomes and maintain disease control, bDMARD treatment is often continued indefinitely in clinical practice [ 14 ]. In addition, despite the appropriate selection, dosing, and adherence of bDMARDs, many patients with axSpA/AS discuss changing their biologics with their physicians [ 15 ]. One of the challenges with biological treatment is ‘wear-off’ between doses, reflecting the experience of diminished treatment efficacy [ 16 ].…”