12/23/2023 0 Comments Atlasti psu7 csDMARDs and tsDMARDs are mostly administered orally, whereas bDMARDs require administration by intravenous infusion or subcutaneous injection. 5, 6 More recent guidelines, jointly published in 2018 by the American College of Rheumatology and the National Psoriasis Foundation, recommend starting a TNFi (bDMARD) over csDMARDs or apremilast (tsDMARD) in treatment-naïve patients with active PsA, and switching to a TNFi over csDMARDs, apremilast, or the Janus kinase inhibitor, tofacitinib, in patients with active PsA despite csDMARD treatment however, the guidelines also acknowledge that treatment with oral medications can be considered if patients prefer these to injectable therapy. 5, 6 For patients in whom these are unsuccessful, biologic DMARDs (bDMARDs), such as tumor necrosis factor inhibitors (TNFi), and targeted synthetic DMARDs (tsDMARDs), such as apremilast (a phosphodiesterase inhibitor), are recommended. 3Īccording to the 2015 evidence-based treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the European League Against Rheumatism, non-steroidal anti-inflammatory drugs and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) should be used in the early treatment of PsA. Psoriatic arthritis (PsA) is a progressive, debilitating, immune-mediated inflammatory disease with multiple disease manifestations and comorbidities, 1 – 4 which can substantially impact patients’ health-related quality of life. Considering these results may support the shared decision-making process between healthcare professionals and patients when choosing the most suitable treatment option. These results give specific explanations for patient preferences regarding PsA treatment modes of administration. However, almost all patients preferred not to have clinic injections because they wanted to avoid visiting the doctor. The few patients who liked clinic injection felt more comfortable with experts giving their treatment, felt safe, and liked the fast results. The most common reason for liking infusion was that it was not administered very often, but patients who disliked infusion wanted to avoid visiting the doctor. Patients mostly liked self-injection because it could be done at home the most common reason for disliking self-injection was to avoid needles and pain. Patients mostly liked how fast and easy it was to take/swallow oral treatments the main reason for avoiding oral treatments was possible interactions with other pills. Oral administration was the first choice for almost half of the patients, followed by self-injection, infusion, and then clinic injection. In this study, patients with PsA were interviewed about their preferences for treating their PsA with the following modes of administration: oral administration once daily, injection weekly (self-injection or injection at a clinic), and infusion monthly. Previous research has shown that patients with PsA usually prefer oral administration, but little is known about the reasons for such preferences. Treatments for psoriatic arthritis (PsA) can be administered by different modes: by mouth (oral administration, eg pills), injection, or drip (infusion). The most commonly reported reason for avoiding oral administration was concern about possible drug interactions (63.6%) for self-injection, this was a dislike of needles or the injection process (66.7%). The most commonly reported reason for oral administration as the first choice was speed and ease of administration (76.2%) for self-injection, this was convenience (75.9%). Oral administration was the first-choice preference in the US (88.0% vs 38.0% in Europe). Self-injection was most often selected as second choice (51.8%), clinic injection as third (49.4%), and infusion as fourth (47.1%). Of 48 (56.5%) patients with a strong first-choice preference (ie point allocation ≥60), 66.7% chose oral administration. Overall, 85 patients were interviewed (female, 60.0% mean age, 49.8 years).
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