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The following is a summary of “Decision Aid–Led Tapering of Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis: A Qualitative Study,” published in the August 2024 issue of Rheumatology by Lee et al.
Decision aids (DAs) can enhance shared decision-making by providing patients and rheumatologists with structured information to guide the tapering of advanced therapies in rheumatoid arthritis (RA).
Researchers conducted a retrospective study exploring the experiences and perspectives of patients and rheumatologists on DA-led tapering of advanced therapy in RA.
They completed semi-structured interviews with patients and rheumatologists, which were subjected to a pilot study of DA-led tapering (i.e., dose reduction) of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in all patients with RA who sustained (≥ 6 months) remission and chose to reduce the therapy after a DA-led shared decision with the rheumatologist. Participants included those participating in the pilot (n=4) and non-participating (n=8) reflexive thematic analysis of audiotaped and transcribed interviews identified themes in the group experiences.
The results indicated that all 6 female patients (n=10) found the DA easy to understand and felt confident in shared decision-making for treatment tapering and flare management. In contrast, the perspectives of rheumatologists on tapering bDMARDs and tsDMARDs (n=12, 5 female) varied significantly, from strong support to complete opposition, affecting their views on the DA. They raised concerns about patient comprehension, potential destabilization of stable conditions, flare risks, and longer appointment times. Despite initial reservations about providing the DA to all eligible patients ahead of appointments, 3 of the 4 participating rheumatologists adopted this approach, promoting patient-led conversations.
Investigators found that a DA-led strategy for tapering advanced therapy in RA was acceptable to patients and feasible in practice. They also noted that sending patients a DA ahead of their appointment facilitated patient-led conversations about tapering.
Source: jrheum.org/content/early/2024/09/11/jrheum.2024-0383
