The Patient Perspective on Bdmard Dose Reduction: A Mixed Methods Study

Background:Dose reduction of bDMARDs, after low disease activity is reached, is safe and effective.(1) To date, few studies have focused on bDMARD dose reduction from the patient perspective.Objectives:The aim of this study was to identify the factors that play a role for patients with RA when considering bDMARD dose reduction, and to determine their relative importance.Methods:A mixed methods design was used in which we 1) identified influencing factors with interviews and 2) ranked these factors using a Maximum Difference Scaling (MaxDiff) survey. Sub study 1: We performed semi-structured interviews with 22 RA patients. Interviews were transcribed verbatim and two researchers analyzed the transcriptions by inductive thematic analysis. Sub study 2: The influencing factors were derived from the interviews and used in a MaxDiff survey with RA patients from 3 different centers in the Netherlands (N=192; an academic hospital, a specialized hospital and a large general hospital). Besides questions about patient characteristics, the survey included 18 MaxDiff questions in which patients were asked to choose the most and least important factor from a subset of 5 factors. A relative importance score for each factor was calculated using hierarchical Bayes modeling.Results:Thirty factors were identified from the interviews and used in the survey. Most respondents had a positive attitude towards bDMARD dose reduction (table 1). The top-10 of factors (table 2) shows that patients are concerned that dose reduction will lead to a disease flare that affects their daily life (pain, function). It is important for them to know that it is possible to increase the dose if (further) reduction is not possible and that the bDMARD will be effective again. Patients value the opinion of their rheumatologist, and being involved in the decision to start tapering is highly ranked as well.Conclusions:The results from this study could facilitate implementation of bDMARD dose reduction by informing care providers on what is important for patients and providing a basis for shared decision making.Reference[1]Nam JL, et al. Ann Rheum Dis2017Jun;76(6):1113–1136.Disclosure of Interest:None declared