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Preventive treatments for rheumatoid arthritis: What do people want?

Preventive treatments for rheumatoid arthritis: What do people want?

Why this research matters

Close relatives of people with rheumatoid arthritis have a high risk of also developing the disease. Several drugs are being tested in clinical trials to see if they can prevent this from happening. A 2019 study shed new light on what would make the best treatment from the consumer perspective, which can now shape how trials are designed and care is delivered.

What is this research about? 

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, which can cause significant pain and disability. First-degree relatives (i.e., parents, siblings, or children) of people with RA have a higher risk of also getting the disease. Some drugs usually used to treat RA are being studied in clinical trials as prevention treatments for this high-risk group. However, most trials focus on how much the risk is lowered, without considering what other factors influence a consumer’s choice to take a preventive drug.

What did the researchers do? 

Dr. Mark Harrison and his team presented over 280 first-degree relatives of people with RA with hypothetical scenarios where they could choose between two preventive drugs with different attributes, or no treatment at all. The researchers analyzed what trade-offs the participants considered when making their choice.

What did they find?  

Participants valued many treatment attributes beyond a drug’s ability to reduce RA risk. Other important considerations included whether it was easy to take the drug (e.g., daily pills), whether it was recommended by a healthcare professional, and whether there were risks of serious side effects. Participants were often willing to sacrifice the level of risk reduction to accommodate other preferences. Overall, predicted uptake was high for non-biologic drugs (particularly those given as pills) but low for biologics.

What is the impact of this research?

This research shows that for people at high risk of developing RA, the decision to take a preventive drug can be complicated. It’s not as simple as whether the drug decreases RA risk – many other factors come into play.

These findings suggest that the consumer perspective needs to be integrated into the planning and design of clinical trials on potential preventive treatments to make sure that consumers and researchers alike will get the answers they need. This study also highlighted the importance of a healthcare professional’s recommendation, supporting a need for educational tools to help patients and doctors make treatment decisions together.

Photography of Dr. Mark Harrison
This project highlighted the complexity of decisions that people are making when they decide to take treatments or not. If we don’t take the time to understand what is important to people, then too often we might be researching treatments that people will not want to take. This explains why sometimes treatments, even if shown to be beneficial in trials, won’t improve outcomes for people. In this work, our results suggest that biologics are unlikely to be a sought-after preventive treatment for RA "

— Dr. Mark Harrison, University of British Columbia

About the researcher 

Dr. Mark Harrison is an associate professor at the University of British Columbia and a scientist at the Centre for Health Evaluation and Outcome Sciences and Arthritis Research Canada. His research has been supported in part by an Arthritis Society Young Investigator Salary Award and an Arthritis Society Strategic Operating Grant, both awarded in 2016, focused on using healthcare teams to improve arthritis care.

Publication citation 

Harrison M, Spooner L, Bansback N, Milbers K, Koehn C, Shojania K, Finckh A, Hudson M. Preventing rheumatoid arthritis: Preferences for and predicted uptake of preventive treatments among high risk individuals. PLoS One. 2019;14(4):e0216075.

Harrison M, Bansback N, Aguiar M, Koehn C, Shojania K, Finckh A, Hudson M. Preferences for treatments to prevent rheumatoid arthritis in Canada and the influence of shared decision-making. Clin Rheumatol. 2020;39:2931-2941.

Research at the Arthritis Society

Through the trust and support of our donors and partners, the Arthritis Society is Canada’s largest charitable funder of cutting-edge arthritis research, investing over $220 million in research projects since our founding. These projects have led to breakthroughs in the diagnosis, treatment and care of people with arthritis. Visit us at arthritis.ca/research