Patient preferences when choosing biological treatments for rheumatoid arthritis

This study looked at rheumatoid arthritis (RA) patients’ preferences when choosing either an infused or an injected biological treatment. It also compared patient reported outcomes (PRO) for treatment with adalimumab (Humira) and etanercept (Enbrel).

Biological drugs are becoming a common treatment for RA. These drugs work by blocking the activity of proteins that are known to contribute to the over-activation of the immune system.

Effectiveness and safety must be the main concern when choosing a treatment option but patient preferences must also be considered. Many of these drugs can be given by injection (takes less than 15 minutes) or infusion (takes longer than 15 minutes). A patient may choose one or the other based on convenience or dislike of needles.

Injection/infusion-site burning and stinging (ISBS) is a common side-effect of these types of drugs and so PROs should be recorded and also be taken into account when choosing a treatment.

267 patients completed a survey where they were asked for their preference on injected or infused biological drugs. 57% said they would prefer an injectable biologic. 22 % said they would prefer an infused biologic. 21% had no preference.

92% of the patients who preferred an injected drug listed convenience as the main reason for their choice. 16% of the patients who would choose an infused drug said a dislike of self-injection was their main concern.

After 6 month 70% of patients who answered an ISBS question reported experiencing ISBS with their final dose of treatment. ISBS was rated on a scale of 1 (none) to 10 (worst). 41% reported a score of 2-5 and 29% reported a score of 6-10. ISBS in patients receiving adalimumab was 3.2 times higher than in patients receiving etanercept. Patients reported no difference between these two drugs in quality of life and disease activity. 

This study concluded that convenience and dislike of injections were important factors for RA patients in choosing a treatment.Adalimumab can cause more burning and stinging at a site of injection than etanercept. No difference was reported between these two drugs in relation to quality of life and disease activity. 

This study was carried out in a single region of the U.S. Some of the authors have connections to the companies that make these drugs.  

Consult with your physician regarding suitable treatments for rheumatoid arthritis.