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Abstract

Despite broadening treatment options for rheumatoid arthritis (RA), challenges and unmet needs remain. This study aimed to characterize patient preferences with current pharmacologic treatments and impressions of an implantable neuroimmune modulation device. A patient survey was conducted, combined with a discrete choice experiment that included 12 choice sets, containing a device profile and drug profile, featuring 8 attributes specific to each. In total, 354 completed surveys were included, 74% female, 79% <60 years, stratified into Biologic Naïve (n = 103); Biologic-Experienced-I (n = 151); and Biologic-Experienced-II (n = 100). Lack of efficacy was the primary reason for treatment discontinuation of conventional disease-modifying antirheumatic drugs (DMARDs) and biologic or targeted synthetic DMARDs. Initial impression of device-based treatment was “Positive” or “Extremely Positive” by 45% and preference ranked higher than current drug treatment options for both Biologic Experienced groups. Key drivers of treatment preference included out-of-pocket cost, symptom improvement, physical function and fatigue, and irreversible joint damage protection. RA patients were accepting of a novel neuroimmune modulation approach, including a surgically implanted device, meeting identified attributes and expectations of safety and efficacy as observed in controlled trials.

Plain Language Title

Patient Preferences for Treatments of Rheumatoid Arthritis: Evaluating Preference for Novel Neuroimmune Modulation Devices

Plain Language Summary

This study found that people with rheumatoid arthritis (RA) are accepting of a novel, surgically implanted neuroimmune modulation treatment approach, reflective of dissatisfaction with ongoing pharmacologic therapy and burden associated with regular infusions, injections, or daily oral therapy. The drivers of patient preference of RA treatment include out-of-pocket treatment cost, proportion of improvement in symptoms, improvement in physical function and fatigue as well as protection from irreversible joint damage. The study concluded that a preference for a device-based treatment remained high across all subgroups and increased as a function of satisfaction with current treatment and the number of lines of prior treatment.

Keywords

rheumatoid arthritis treatment preferences treatment satisfaction decision-making survey

Introduction

The main goal of rheumatoid arthritis (RA) treatment is to achieve and maintain remission or low disease activity to prevent joint damage and disability, while also improving quality of life. In recent decades, the management of RA has evolved from conventional synthetic disease-modifying antirheumatic drugs (cDMARDs) to include biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) such as Janus Kinase inhibitors (JAKi). The 2021 Guidelines from the American College of Rheumatology (ACR) have made several recommendations addressing treatment sequencing with cDMARDs, bDMARDs, tsDMARDs, as well as glucocorticoids, and the use of treatments in high-risk populations.¹ An important consideration in the development of these recent guidelines was the incorporation of patient input into treatment decisions to reflect their expressed values and preferences.

Despite the broadening of RA treatment options, several challenges and unmet medical needs remain. Real-world analysis from a large RA patient registry highlighted that almost one-third (32.7%) of patients in the United States receiving bDMARDs discontinue prescribed therapies by 12 months, and almost half (48.9%) by 24 months, most commonly due to loss of efficacy (35.8%).² The introduction of oral tsDMARDs has not improved therapy adherence rates, with less than 30% treatment retention 2 years after initiating JAKi therapy.³ Moreover, while the safety profile of b/tsDMARDs is generally accepted by rheumatologists and RA patients, they are not without potential side effects and serious adverse events (eg, infection requiring hospitalization, gastrointestinal perforation, malignancy, venous thromboembolism).

Neurostimulation devices have been evaluated as a treatment option for RA patients who do not achieve a complete response, or may not be able to tolerate b/tsDMARD therapy. A recent randomized, sham-controlled, double-blind pivotal study included 122 participants who received active neuroimmune modulation treatment with a miniaturized integrated neurostimulator that electrically stimulated the vagus nerve for 1-min daily on a preset schedule (SetPoint System, SetPoint Medical, Valencia CA).³ Within this pivotal study, neuroimmune modulation treatment was well tolerated, and patients with prior b/tsDMARD exposure experienced a significantly higher American College of Rheumatology 20% (ACR20) response, improvements in magnetic resonance imaging erosion score and probability of achieving DAS28-CRP (C-reactive protein) low disease activity or remission at week 12, compared to the control group. These improvements were sustained through 12 month follow-up.³

To date, no studies have explored RA patients’ preferences for novel neuroimmune modulation devices. This study used a discrete choice experiment (DCE), alongside a patient satisfaction survey, to assess patients’ willingness to adopt such therapies and to identify the treatment attributes that most strongly influenced their decision-making.

Materials and Methods

To fully capture the experiences, perspectives, and preferences of those living with RA, the current study was conducted in 2 parts, a patient survey of treatment experiences and a DCE. DCEs are a widely utilized tool in economics research that can elicit an individual's distinct valuation of several different options, and account for trade-offs between them, based on their personal experiences and current circumstances. DCEs with situational attributes ask participants to make repeated choices between alternatives depicted by different attribute levels of the matter being studied, such as treatment for a specific disease state, to inform healthcare decision-making.^4,5

Study Population

People living with RA were recruited via email using a national panel of patients in the United States. Survey participants could be screened for participation if they had received their diagnosis of RA 2 or more years prior; had been diagnosed, treated, or had a consultation with a rheumatologist; and were currently receiving treatment for their RA with a conventional or b/tsDMARD. All screening and survey details were self-reported, and patients received nominal compensation for their participation via an electronic gift card.

Patient Preference Survey

The survey was developed by SetPoint Medical in collaboration with clinical expert and RA patient input. Questions were original and designed to elicit feedback regarding participants’ disease severity, treatment patterns, and satisfaction with current RA treatment. The content for survey questions and research stimuli was developed based on several sources, including a comprehensive literature review of published RA and preference literature.^6–9

Prior to survey initiation, all materials were reviewed, and a waiver was granted by Aspire, an independent review board, on January 15, 2020, under 45 CFR § 46.104(d). Participation in the survey was voluntary, and all participants provided informed consent online for their data to be used anonymously or in aggregate prior to entering the survey. The survey was double-masked and no participant identifying information was collected or shared with the sponsor. Participants completed the survey online via a secure web portal/electronic data capture system that took a mean of 26 min and a median 21 min to complete. All online surveys, including the DCE exercise, were completed between January 24 and February 15, 2020.

The structure of survey questions included multiple-choice questions, rank-order questions (order of importance 1-5), and scale-based responses using a symmetrical 5-point Likert scale of agreement, with presented statements (from “strongly disagree” to “strongly agree”) consistent with established self-reporting survey methodology.¹⁰ Disease severity was captured using a self-reported scale, and disease activity was measured by the RAPID3 (Routine Assessment of Patient Index Data 3), a validated pooled index of the 3 patient-reported RA core data set measures: physical function, pain, and patient global measure: function, pain, and patient global estimate of status.¹¹ In the current study, categories for satisfaction were used based on those previously defined in the Treatment Satisfaction Questionnaire for Medication (TSQM), a validated instrument to measure patient satisfaction with their treatment across the domains of effectiveness, side effects, convenience, and global satisfaction.¹²

Participants were stratified into 3 groups based upon common RA treatment patterns reflective of ACR treatment guidelines.¹ These groups consisted of: Biologic Naïve (n = 103)—those whose treatment experience has been limited to cDMARD(s) such as methotrexate and/or hydroxychloroquine; Biologic Experienced I (n = 151)—those who have experience treating their RA with their first bDMARD (eg, a tumor necrosis factor [TNF] inhibitor [TNFi]), with or without cDMARD(s); Biologic Experienced II (n = 100)—those who have prior experience treating their RA with multiple (2 or more) distinct b/tsDMARDs (within the same class or across multiple classes), with or without cDMARD(s).

A formal sample size calculation was not performed, as it is dependent on the values of the unknown parameters estimated in DCEs. Therefore, a minimum of 300 respondents was targeted for overall sample, based on commonly accepted minimum sample size per DCE guidance.^13,14 A sample of 300 would provide the desired precision of the results to yield a standard error of 0.25 and a 95% confidence interval of approximately ±0.5. The analysis plan specified continuous variables to be summarized as means, medians, and ranges, and categorical variables as frequency distributions and percentages.

Discrete Choice Experiment (DCE)

As the DCE aimed to more accurately reflect those patients who may benefit from a change in therapy, the study population excluded survey participants that were biologic naive, satisfied with their current treatment based on the TSQM, and in near remission/low disease severity as defined the RAPID3.

A list of clinically relevant attributes related to currently available RA treatments and realistic clinical scenarios were created based on review of the published literature, approved drug labels, interviews with a pilot sample (n = 6) of RA patients, and rheumatologist expert input.^15,16 The base case “product profiles” of RA therapies and the attributes and levels that varied within the DCE are listed in Table 1. Attributes compared a miniaturized neuroimmune modulation device and “Drug,” each of which was designed to reflect a specific drug class (TNFi, JAKi, interleukin [IL] inhibitors) that are currently Food and Drug Administration (FDA)-approved and available by prescription in the United States. The range of levels included for each drug attribute was based on a review of the clinical data supporting the approval of drugs in the class as well as prescribing instructions for relevant Biologic Experienced patient cohorts. Prior to initiating the DCE, participants were provided with background information briefly describing RA, b/tsDMARDs and in greater detail, the neuroimmune modulation device (SetPoint System, SetPoint Medical, Valencia CA), and its surgical implantation procedure. During the DCE, participants were provided a hyperlink to the background information for the neuroimmune modulation device should they wish to review the information again.

Table 1.

Base Case Profiles of Treatment Options.

	Neuroimmune Modulation Device	TNF Inhibitors (Subcutaneous)Based on Adalimumab	JAK InhibitorBased on Tofacitinib	IL-Inhibitor(Subcutaneous)Based on Tocilizumab
The percent of patients that after 3 months: Have improved physical function (eg, getting out of bed, showering, getting dressed, doing chores, walking short distances) Have improvement in fatigue Have improvement in their RA symptoms, including pain and swelling	27%	23%	30%	25%
The percent of patients protected from irreversible joint damage after 12 months	83%	88%	87%	85%
Risk of shingles (chicken pox virus) every year you are on the drug	None	15 in 1000 patients	45 in 1000 patients	15 in 1000 patients
Risk of serious infection requiring intravenous (into the vein) antibiotics or hospitalization every year you are on the drug	2 in 100 patients	6 in 100 patients	6 in 100 patients	6 in 100 patients
Risk of blood clot in the legs or lungs that requires long-term blood thinners every year you are on the drug	None	None	2 in 1000 patients	None
Risk of a hole developing in part of the gastrointestinal tract (esophagus, stomach, large bowel, or small intestine) every year you are on the drug	None	None	1 in 1000 patients	None
Nonserious side effects	Post-surgical side effects typical of general anesthesia Vocal cord weakness following implantation of the device	Occurs with all subcutaneous dosage forms Nonserious infections, like sinus infections or common colds Subcutaneous injection sometimes causes redness at the site of injection that typically last 1-2 days	Occurs with all oral dosage forms Nonserious infections, like sinus infections or common colds Mild nausea and stomach upset	Occurs with all subcutaneous dosage forms Nonserious infections, like sinus infections or common colds Subcutaneous injection sometimes causes redness at the site of injection that typically last 1-2 days
Dosage form and frequency of the treatment	1-time surgical implantation of device	Subcutaneous injection you give yourself every 2 weeks	Oral tablet once per day	Subcutaneous injection you give yourself every 2 weeks
Cost to patient (out-of-pocket)	$5000 1-time cost for surgery followed by $0 per month	$50 every month ($600 per year)	$50 every month ($600 per year)	$50 every month ($600 per year)

Abbreviations: RA, rheumatoid arthritis; JAK, Janus Kinase.

A multiattribute DCE called a choice-based conjoint was used for this study. The DCE applied a minimal overlap efficient design created in survey research software, Lighthouse Studio v9.8 from Sawtooth Software, Inc. The DCE used a “labeled” or alternative-specific design so that each of the 12 choice sets presented to a respondent contained a device profile and 1 drug profile, and the respondent had to choose 1 or the other. In addition to the label attribute and 1 generic attribute shared by both profiles (eg, “percent of patients protected from joint damage”), the experiment featured 8 attributes specific to the device and 8 attributes specific to drug therapy, as shown in Table S1 in the Supplemental materials. After the forced choice between the device and drug profiles, each choice set had a follow-up question (a “dual response none” question) allowing them to indicate whether they would opt for the therapy they had chosen rather than maintain their current therapy without change. An example of the patient preference DCE exercise is presented in Table S2 in the Supplemental materials.

Respondents’ choices were modeled as a function of the variables in the experimental design and resulting coefficients (or “utilities”) were estimated using a Bayesian mixed logit model (hierarchical Bayesian multinomial logit [HB-MNL]).¹⁷ This version of the multinomial logit choice model was selected based on its ability to accommodate respondent heterogeneity by producing respondent-specific sets of utilities, 1 per level for each of the design variables.^18,19 Because of the complexity of the model, we allowed the hierarchical model to go through 40 000 “burn-in” iterations to allow for convergence before running an additional 10 000 draws, and every one-hundredth was used to compute our utilities. Ninety-nine draws were skipped after each one to prevent the ill effects of serial correlation on the draws. Point estimate of these saved draws were used as utility estimates. The utilities are the results of the Bayesian mixed logit analysis, the respondent-level measures of the value of each level of each attribute in the experiment. They are scaled to predict choices using the multinomial logit choice rule. Diagnostic, interim, and final models were produced using the HB-MNL estimation routine built in the Lighthouse Studio v 9.8 software package.

Results

Profile of Respondents

Overall, 689 unique individuals with RA entered the survey screener. Of these, 68 were not receiving any form of RA treatment and 267 had no prior experience with cDMARD treatment. Therefore, the remaining study population included 354 participants that met the inclusion criteria and completed the survey, resulting in a 51% response rate. All 354 participants completed the entire survey, including the DCE exercise. The sample was predominantly female (74%), and most were younger than 60 years of age (79%), as is shown in Table 2. There were participants from all but 5 of the 50 states with Texas having the highest representation with 33 participants.

Table 2.

Participant Characteristics.

	Total (n = 354)	Biologic Naïve (n = 103)	Biologic Experienced I (n = 151)	Biologic Experienced II (n = 100)
Gender
Female	74%	83%	72%	69%
Male	26%	17%	28%	31%
Age
Less than 40 years	31%	33%	27%	33%
40-59 years	48%	43%	54%	46%
60+ years	21%	24%	19%	21%
Mean	47.8	48.0	47.6	48.0
Years with RA symptoms (mean)	11	10	11	11
Years with current physician (mean)	6	5	6	8
Disease severity (self-report)
Mild	4%	7%	4%	2%
Mild-to-moderate	15%	22%	13%	11%
Moderate	39%	31%	44%	40%
Moderate-to-severe	34%	34%	34%	35%
Severe	8%	6%	6%	12%
Disease severity (RAPID3)
Near remission	7%	9%	7%	5%
Low severity	7%	9%	7%	5%
Moderate severity	27%	23%	27%	29%
High severity	60%	59%	59%	61%
Experienced joint damage
Yes	66%	62%	68%	66%
No	21%	17%	21%	26%
Don’t know	13%	21%	11%	8%
Had joint surgery
Yes	16%	13%	14%	22%
No	84%	87%	86%	78%
Duration of therapy (mean), years
cDMARDs (n = 189)	6	5	5	6
b/tsDMARDs (n = 194)	3	-	4	3
Current treatment (% of patients)
cDMARDs	53%	86%	43%	35%
TNF inhibitors	52%	-	46%	61%
JAK inhibitors	18%	-	15%	22%
IL inhibitors	4%	-	5%	4%
T-cell Inhibitors	3%	-	2%	4%
TSQM score
Dissatisfied (35 or less)	6%	8%	7%	5%
Somewhat satisfied (36-79)	62%	68%	61%	56%
Satisfied (80-100)	32%	24%	32%	39%

Abbreviations: RA, rheumatoid arthritis; cDMARD, conventional synthetic disease-modifying antirheumatic drug; bDMARD, biologic disease-modifying antirheumatic drug; tsDMARD, targeted disease-modifying antirheumatic drug; JAK, Janus Kinase; RAPID3, Routine Assessment of Patient Index Data 3; TSQM, Treatment Satisfaction Questionnaire for Medication.

cDMARDs (includes methotrexate, hydroxychloroquine, leflunomide, and azulfidine); TNF inhibitors (certolizumab pegol, enantercept, adalimumab, golimumab, and infliximab); JAK inhibitors (tofacitinib, upadacitinib, and baricitinib); IL inhibitors (tocilizumab and sarilumab); T-cell inhibitor (abatacept); B-cell inhibitor (rituximab).

When participants were asked to self-report the severity of their RA, 39% reported it as “Moderate,” 34% “Moderate to Severe,” and 8% reported having “Severe” disease. The results from the RAPID3 suggested more active disease, with 27% of patients rating themselves as having “Moderate Disease Activity” (RAPID3 6-12) and 60% “High Disease Activity” (RAPID3 > 12).

Patient Satisfaction Survey: Treatment Satisfaction and Discontinuation

Responses to the TSQM are summarized in Table 2 and reasons for discontinuation are presented in Figure S1 in the Supplemental materials. Patients self-selected lack of efficacy as the primary reason for treatment discontinuation of cDMARDs as well as b/tsDMARDs. Experiencing too many side effects also contributed to discontinuation of both cDMARD and b/tsDMARDs; those who discontinued a b/tsDMARD were more apt to note cost/insurance issues.

Discrete Choice Experiment

Following a review of the background information for the neuroimmune modulation device, 45% of patients described their initial impression of the device as “Positive” or “Extremely Positive.” Ratings on a 7-point scale (0 = extremely negative to 7 = extremely positive) did not differ across subgroups.

Among Biologic Experienced patients (subgroups I and II) with moderate to high severity of disease as defined by the RAPID3 and who self-reported as being “dissatisfied” or “only somewhat satisfied” with therapy as defined by the TSQM, preference for the neuroimmune modulation device over drug was found to vary as a function of treatment. The resulting preference shares using the base case assumptions indicate that patients in the Biologic Experienced I subgroup were more likely to prefer the neuroimmune modulation device (48%) over a JAKi (32%) or another TNFi (20%). Patients with the most treatment experience, the Biologic Experienced II subgroup, who also had more severe disease and were among the least satisfied with currently available treatment options, similarly preferred the device over an IL inhibitor or a JAKi (preference shares 46%, 33%, and 21% respectively), as shown in Figure 1.

Figure 1.

Patient preferences by biologic experience.

The DCE also allowed for an analysis of preference among patients in the Biologic Experienced subgroups that had discontinued therapy due either to inadequate response or safety/adverse events. Overall, no major difference was seen in therapy preferences between the Biologic Experienced (I/II) subgroups and those who had discontinued therapy due to safety or adverse effects with 41% preferring the device, compared to 24% and 34% for drug options (TNFi and JAKi, respectively). Similarly, of those who discontinued b/tsDMARDs due to inadequate response, almost half (46%) preferred the device, compared to 21% and 33% for drug treatment (TNFi and JAKi), respectively.

The attribute sensitivity is shown in Figure 2. Notable drivers of preference included out-of-pocket treatment cost, and therapy effectiveness measures such as proportion of improvement in symptoms, physical function and fatigue, defined by patients achieving low disease activity or remission as measured by DAS28-CRP, as well as protection from irreversible joint damage at 12 months.

Figure 2.

Attribute sensitivity.

Results of the DCE demonstrated that Biologic Experienced RA patients are sensitive to out-of-pocket treatment cost, but not to the exclusion of other attributes. While a $0 per month drug was extremely desirable, the neuroimmune modulation device, with an initial 1-time surgical cost of $2000 and $0 per month follow-up cost was also very attractive. An increase in initial 1-time surgical cost of $5000 followed by $0 per month for the neuroimmune modulation device was preferred over $200 per month cost for drug.

Participants were found to be maximally sensitive to changes in efficacy (defined by the percentage of patients whose RA symptoms improved such that they achieved low disease activity or remission as measured by DAS28-CRP) of the device between 40% and 50%. Participants were also sensitive to changes in effectiveness of joint protection as defined by the percentage of patients protected from irreversible joint damage or erosions at 12 months. They were maximally sensitive to changes between 95% and 85%.

Among the various drug options, participants preferred subcutaneous injections every 1 or 2 weeks over daily oral tablets. Infusions were least preferred among various drug administration options tested.

Although participants acknowledged serious side effects, such as shingles, serious infection, blood clot, or gastrointestinal perforation, they did not distinguish between the incidence rates tested in the DCE model; all rates of these events were perceived to be extremely low and not considered to drive decision-making of RA treatment choice.

Discussion

The recent SENSE study confirmed that suboptimal RA disease control adversely impacts treatment satisfaction and translates negatively into work ability, overall quality of life, and health resource utilization.²⁰ Importantly, RA treatment satisfaction and perceived level of disease suppression have been identified in previous studies to be the main risk factors for treatment nonadherence.^21,22

A previous cross-sectional study of RA patients in the United States showed that approximately one-quarter of RA patients are satisfied with their drug-based treatment, highlighting an ongoing recognition of the significant unmet need for better disease management options.¹² The current study observed that patients tended to prefer the neuroimmune modulation device over current drug treatments across both Biologic Experienced (I/II) subgroups, signaling a patient desire to try a new, nondrug option. These preferences were maintained even in scenarios where efficacy assumptions, based on clinical trial evidence of proportion of patients achieving low disease activity or remission, for the neuroimmune modulation device were the same or lower than drug options. Preference for a device-based treatment may also reflect the observed dissatisfaction with ongoing pharmacologic therapy. In the present study, only 32% of patients reported being satisfied with their treatment as classified by TSQM scores.

In the development of this survey, it was important to use validated measures and findings from the published literature, but there was also a focus on eliciting feedback on the true patient experience. Particular care was taken to use and pilot test patient-facing language within the survey that could easily connect personal treatment experiences and outcomes to clinical efficacy and improvements in disease activity. Clinical measures used to assess the severity of disease, such as a ACR20 response and disease activity score (eg, disease activity score [DAS] or clinical disease activity index [CDAI]), may not fully or accurately reflect how a patient is actually feeling or experiencing their symptoms, often indicating a disparity between objective medical data and subjective patient perception of their condition.^23,24 In contrast, the DCE incorporated improvement in RA symptoms (pain, swelling, fatigue, physical function) and percent of patients protected from irreversible joint damage, to better reflect outcomes most important to the RA patient.

Out-of-pocket treatment cost was also a key driver of patient preference. Surgical procedures to implant devices, such as the neuroimmune modulation device, typically have a 1-time upfront cost for the patient compared to monthly copayments for pharmacotherapy. A 1-time payment for surgery, even if it was magnitudes greater than monthly payment for drug treatment, was significantly preferred and further supports the cost effectiveness potential of neuroimmune modulation over b/tsDMARD therapy.

The strengths of our study include the rigorous process to establish valid and important survey questions and attributes through previously published literature, drug utilization and prescribing patterns, interviews with patients and expert input. Additionally, measures of efficacy used in the DCE for the device and drug treatment options were supported by published clinical trial data in represented biologic experienced patient populations, so as to avoid any perceived exaggeration of efficacy.^3,25

The current findings should be interpreted considering the following limitations. The anonymity of the survey prevents verification of self-reported data associated with demographics, treatment patterns, and treatment efficacy. The study was not powered to elicit differences by gender or age group, but this may be an area to consider in future research. Our study is also subject to sampling bias. Although we encountered a good response rate for an online, web-based survey, it was administered in English only, does not fully reach certain populations including those with limited access to the Internet, and non-English speakers. Analysis of our population showed that participants were skewed slightly younger than anticipated, which may render a preference toward technology or device therapy. There may also be a volunteer bias where people who participated in the survey have preferences that do not generalize more widely. Additionally, this study was conducted in early 2020, prior to COVID-19 and prior to the US FDA expanded black warnings on some RA drug therapies, potentially not representing treatment patterns, preferences, or safety considerations (eg, related to JAKi) that may have changed because of those circumstances.

Conclusion

People living with RA reported that despite a multitude of current treatment options available, unmet needs, primarily associated with patient perceived lack of efficacy, remain. The results presented here highlight that RA patients were accepting of a novel neuroimmune modulation approach, delivered via surgically implanted device, that met the identified attributes and expectations of safety and efficacy. Further, this expressed acceptance and preference for the neuroimmune modulation device over other presented options was particularly high for those that had previous exposure to, and dissatisfaction with different currently available therapies. The results underscore the importance of discussing patients’ personal preferences, their experiences with prior therapies, and the attributes of treatment that are most important to them in making future treatment selections.

Supplemental Material

sj-docx-1-jpx-10.1177_23743735251415236 - Supplemental material for Patient Preferences for Treatments of Rheumatoid Arthritis: A Discrete Choice Experiment Evaluating Preference for Novel Neuroimmune Modulation Devices

Supplemental material, sj-docx-1-jpx-10.1177_23743735251415236 for Patient Preferences for Treatments of Rheumatoid Arthritis: A Discrete Choice Experiment Evaluating Preference for Novel Neuroimmune Modulation Devices by Jeffrey R. Curtis, Shilpa Venkatachalam, Sherry Danese, Julie Ulloa and Joshua Fitzgerald Baker in Journal of Patient Experience

Footnotes

Acknowledgments

The authors thank those who participated in this study and the authors also acknowledge April Ingram for writing contributions and manuscript preparation.

Author Contributions

Study concept and design: Jeffrey R. Curtis, Sherry Danese, and Julie Ulloa; acquisition of data: Sherry Danese and Julie Ulloa; analysis and interpretation of data: Jeffrey R. Curtis, Sherry Danese, Julie Ulloa, Shilpa Venkatachalam, and Joshua F. Baker; drafting of the manuscript: Julie Ulloa; revising it for intellectual content: Jeffrey R. Curtis, Sherry Danese, and Julie Ulloa; final approval of the completed manuscript: Jeffrey R. Curtis, Sherry Danese, Julie Ulloa, Shilpa Venkatachalam, and Joshua F. Baker.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval and Informed Consent Statements

Survey materials were reviewed, and a waiver was granted by Advarra, an independent review board prior to study initiation, under 45 CFR § 46.104(d).

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was sponsored by SetPoint Medical.

Supplemental Material

Supplemental material for this article is available online.

ORCID iD

Jeffrey Curtis

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