OP0103 PATIENT PREFERENCES FOR TREATMENT OF NEWLY DIAGNOSED RHEUMATOID ARTHRITIS
J.K. De Vries-Bouwstra, Y.P.M. Goekoop-Ruiterman, P.J.S.M. Kerstens, D. Van Zeben, F.C. Breedveld, B.A.C. Dijkmans, J.M.W. Hazes, A.H. Zwinderman, C.F. Allaart BeSt Trial Group, Rheumatology, FARR, Leiden

RA patients who participated in the BeSt trial were asked to complete a questionnaire about their experiences and preferences since the start of treatment. (see OP0001 for results from the BeSt trial examining radiographic outcomes)

Methods: 508 patients with RA < 2years and no prior DMARD therapy were randomized to one of four treatment groups: Group 1 (n=125): Sequential monotherapy starting with methotrexate (MTX) up to 25 mg/week, next treatment step sulphasalazin (SSA), followed by leflunomide; Group 2 (n=122): Step-up therapy from MTX, next step add SSA, then add hydroxychloroquine; Group 3 (n=133): Step-down therapy from MTX + SSA + prednisone 60 mg tapered to 7.5 mg; and Group 4 (n=128): Treatment with MTX (7.5 mg/wk for 2 weeks, then 15 mg/wk) and infliximab (3 mg/kg at week 0, 2, and 6, then every 8 weeks, doses increased or reduced to zero depending on disease activity score (DAS44)).

Results: 357 RA study participants completed and returned the questionnaires. A greater percentage of patients in Group 4 (75%) reported that their general health had much or very much improved compared to Groups 1-3, 56%, 60%, and 50% respectively. More patients in Group 3 (80%) and Group 4 (86%) said that they had improved quickly compared to patients in Group 1 (51%) and Group 2 (57%). No differences were noted between groups 1-4 when patients were asked if they found their current health status and treatment acceptable for the next year (87%, 86%, 75%, 87%, respectively), although Group 3 was least acceptable.

Given the choice, 81% of patients in group 4 stated a preference for the same treatment to which they had been randomized, 36%, 30%, and 41% for Groups 1, 2, and 3, respectively. Objections to taking prednisone among patients in Group 3 (49%) were higher than objections to coming to the hospital to receive iv treatments in Group 4 (4%).

Irrespective of randomized treatment assignment during the study, 44% of all patients stated a preference for treatment with 'the newest intravenous (iv) antirheumatic drug': Group 1 (41%), Group 2 (30%), Group 3 (22%), and Group 4 (81%).

Conclusion: Overall, patients who responded to the questionnaire reported benefiting greatly from their treatment, especially those in Group 4, and would continue for the next year.

Editorial Comments: These data are somewhat self-fulfilling since patients were questionned after treatment rather than before. It is interesting to note, however, the apparent attractiveness of "new" treatments (i.e., infliximab) and the fairly consistent disenchantment with steriods (i.e., prednisone).

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