Rheumatiod arthritis: Treatment options

Rheumatoid arthritis (sometimes called “RA”) is a common chronic inflammatory disease that affects around 1% of the population. It is 3-4 times more common in women. In most cases, patients begin having symptoms between 40 to 60 years of age, but it can begin earlier, or later in life.

RA affects the joints and causes pain, swelling, and stiffness, but also fatigue. If patients are not treated, the joints can suffer permanent damage, which subsequently can lead to disability. To date, there is no cure, which means that all treatments are long term, with the aim to control the inflammatory disease activity and reduce symptoms.

There is a number of disease-modifying antirheumatic drugs on the market known as DMARDs. These drugs target the inflammation in different ways, and there are some practical differences for the patient: How they take the drug, how often they need to take it, different risks of side effects and tests they need to take.

When someone is first diagnosed with RA, they often start treatment with conventional drugs known as ‘synthetics’ (or csDMARDs). If treatment doesn’t work, or if there are too many side-effects, patients often needs to step up treatment to ‘biologics’ (known as bDMARDs), or what is known as ‘targeting synthetics’, also known as JAK-inhibitors (or tsDMARDs). These drugs target specific biological mechanisms that are associated with the start and progression of inflammation. The side effect and the long-term outcomes are well known for older biologics. However, the JAK-inhibitors recently became available so there is still uncertainty in adverse events and the long-term outcomes.

Treatments affect patient’s quality of life. Finding the best treatment for patients with RA that need to change their medication means choosing from a number of drugs with different side effects and practical considerations. Like if patients prefer pills, injections or intravenous treatment. Or how often they are willing to take the drug.

We want to explore the preferences of patients with RA to find out what trade-offs they are willing to make for treatments with JAK-inhibitors compared to biologics, to support clinical and regulatory decisions in deciding which treatment is best suited for patients.

Fact sheet

Therapeutic area Rheumatiod arthritis
Study led by Uppsala University
PREFER lead team Karin Schölin-Bywall

Ulrik Kihlbom
Jorien Veldwijk
MPLC decision point of interest Marketing authorisation and post-marketing
PREFER case study acronym N/A
Clinical objectives To elicit RA patients’ preferences

To estimate Minimum Acceptable Benefit

To explain preference heterogeneity
Patients from Sweden
Methods in Qualitative study Focus groups
Nominal group technique
Methods in Quantitative study Discrete Choice Experiment (DCE)
End-date qualitative data collection March 2019
End-date quantitative data collection November 2019