Dataset Information

Doctors' preferences in de-escalating DMARDs in rheumatoid arthritis: a discrete choice experiment.

ABSTRACT:

Background

Current guidelines suggest reduction of DMARDs can be considered in RA patients in remission. Objectives were (1) to estimate the relative importance of patient characteristics rheumatologists consider in their decision to de-escalate (2) to assess whether heterogeneity exists among rheumatologists with respect to de-escalation and (3) to identify the preferred de-escalation strategy.

Methods

A discrete choice experiment (DCE) was conducted. All rheumatologists and trainees in The Netherlands were invited to participate. A conditional logit model was estimated to assess overall preference for de-escalation and its determinants. Heterogeneity was estimated by latent class analysis.

Results

The DCE questionnaire was completed by 156 doctors. This questionnaire was constructed using the results of semi-structured interviews with 12 rheumatologists that identified five patient characteristics relevant for de-escalation: number of swollen joints (SJC), presence of DAS remission/low disease activity (LDA), patient history, duration of remission/LDA and patient willingness to de-escalate DMARDs. Overall SJC and patient history were most important. Latent class analysis revealed five subgroups of doctors, showing differences regarding willingness to de-escalate and relative importance of patient characteristics. De-escalation of the TNF inhibitor rather than methotrexate first was the most preferred strategy.

Conclusions

Rheumatologists are not uniform in their decision on whom to de-escalate. Differences emerged in which characteristics they traded off resulting in five subgroups: those that taper (1) always, (2) in absence of swollen joints, (3) in absence of swollen joints and presence of favorable patient history, (4) in DAS remission and favorable patient history, and (5) taking into account all factors.

SUBMITTER: Kuijper TM

PROVIDER: S-EPMC5405491 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Doctors' preferences in de-escalating DMARDs in rheumatoid arthritis: a discrete choice experiment.

Kuijper T Martijn TM Folmer Riëtte R Stolk Elly A EA Hazes Johanna M W JMW Luime Jolanda J JJ

Arthritis research & therapy 20170426 1

<h4>Background</h4>Current guidelines suggest reduction of DMARDs can be considered in RA patients in remission. Objectives were (1) to estimate the relative importance of patient characteristics rheumatologists consider in their decision to de-escalate (2) to assess whether heterogeneity exists among rheumatologists with respect to de-escalation and (3) to identify the preferred de-escalation strategy.<h4>Methods</h4>A discrete choice experiment (DCE) was conducted. All rheumatologists and trai ...[more]

PMID: 28446212

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Dataset Information

Doctors' preferences in de-escalating DMARDs in rheumatoid arthritis: a discrete choice experiment.

Background

Methods

Results

Conclusions

Publications

Doctors' preferences in de-escalating DMARDs in rheumatoid arthritis: a discrete choice experiment.

Similar Datasets

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