Pos0644 understanding reasons influencing patients’ preferences for the mode of administration of anti-rheumatic drugs in inflammatory arthritis. a qualitative study

Background The mode of administration is the third most important factor influencing patient preferences for the choice of antirheumatic drugs, after treatment benefit and risk of adverse events (ref1), with 30% of patients placing route and frequency of administration as their top choice (ref2). Objectives To understand the reasons of preferences of the patients with inflammatory arthritis (IA) towards the mode of administration of DMARDs (disease modifying anti-rheumatic drugs). Methods A qualitative study was conducted to explore the patients’ perceptions and practices of DMARDs. The interviews were conducted by 3 anthropologists using in-depth semi directive and biographical methods, registered, transcribed and analysed using a thematic content analysis approach. Six domains were explored: (i) daily life with IA, (ii) practices of pharmacological and non-pharmacological treatments, (iii) the patient’s social and work relationships, (iv) history of the patient pathway, (v) the patient–doctor relationship, decision-making, and (vi) medication daily management. The themes and subthemes related to the mode of administration (route and frequency of administration) were individualized. Results Overall 42 patients were included: 33/42, (33/42), with median age 51 years (17-82): 33 had rheumatoid arthritis (RA), 7 spondyloarthritis (SpA) and 2 psoriatic arthritis (PsA); 22 treated by cDMARDs, 19 by bDMARDs, 12 by JAK inhibitors (JAK-i), in monotherapy or combotherapy, 31 patients having more than 1 line of treatment. Four domains were found to influence patients’ preferences: constraints and mental load, rituals and habits, empowerment versus a passive role, representation of disease for the patient and close ones. Subthemes are in Table 1. Table 1. 8 subthemes associated with preference of patients for mode administration. Subthemes Intravenous Subcutaneous Oral Time constraints Half a day each month or more Once a week or more Every day/week Logistical constraints To stay available for appointments in hospital Refrigerator storage, cold chain No constraints in storage Mental load To stay available Think about medication each week or more Think about medication each day (for Jak-i) Rituals Rituals are managed and imposed by the hospital Needs specific rituals from the patient Integrated to existing rituals (i.e. meals) Risk of forgetting treatment Know what to do in case of skipped dose Forgetting is a common phenomenon Transfer of a medical procedure Total medicalization, patient has a passive role A medical procedure needs to be learnt Tablets are more commonplace Feeling ill To go to the hospital makes you feel sick Seeing the nurse makes you feel sick Taking the tablets is more routine The disease is made visible to others To go to the hospital « Sharing the fridge » An injection means a more serious disease Tablets are more unobtrusive Conclusion Although many studies have looked for patients preferences, the reasons of the patients’ choices for the mode of administration of targeted DMARDs were not well known. The reasons go beyond the simple “fear of needles” and reflect the integration of the treatment in the patients’ representations and daily life and the visibility of the disease. This study brings clues that will help shared decision-making. Reference [1]Durand C et al. J Rheumatol. 2020;47:176-187. 2.Bywall, KS et al. Arthritis Res Ther. 2020; 22:288 Acknowledgements: NIL. Disclosure of Interests None Declared.