Preferences of patients with rheumatoid arthritis regarding disease-modifying antirheumatic drugs: A discrete choice experiment

Milou van Heuckelum*, Elke G.E. Mathijssen, Marcia Vervloet, Annelies Boonen, Renske C.F. Hebing, Annelieke Pasma, Harald E. Vonkeman, Mark H. Wenink, Bart J.F. van den Bemt, Liset van Dijk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)
60 Downloads (Pure)


Background: Although patients have different treatment preferences, these individual preferences could often be grouped in subgroups with shared preferences. Knowledge of these subgroups as well as factors associated with subgroup membership supports health care professionals in the understanding of what matters to patients in clinical decision-making. Objectives: To identify subgroups of patients with rheumatoid arthritis (RA) based on their shared preferences toward disease-modifying antirheumatic drugs (DMARDs), and to identify factors associated with subgroup membership. Methods: A discrete choice experiment to determine DMARD preferences of adult patients with RA was designed based on a literature review, expert recommendations, and focus groups. In this multicenter study, patients were asked to state their preferred choice between two different hypothetical treatment options, described by seven DMARD characteristics with three levels within each characteristic. Latent class analyses and multinomial logistic regressions were used to identify subgroups and the characteristics (patient characteristics, disease-related variables, and beliefs about medicines) associated with subgroup membership. Results: Among 325 participating patients with RA, three subgroups were identified: an administration-driven subgroup (45.6%), a benefit-driven subgroup (29.7%), and a balanced subgroup (24.7%). Patients who were currently using biologic DMARDs were significantly more likely to belong to the balanced subgroup than the administration-driven subgroup (relative risk ratio (RRR): 0.50, 95% CI: 0.28–0.89). Highly educated patients were significantly more likely to belong to the benefit-driven subgroup than the balanced subgroup (RRR: 11.4, 95% CI: 0.97–133.6). Patients’ medication-related concerns did not contribute significantly to subgroup membership, whereas a near-significant association was found between patients’ beliefs about medication necessity and their membership of the benefit-driven subgroup (RRR: 1.12, 95% CI: 1.00–1.23). Conclusion: Three subgroups with shared preferences were identified. Only biologic DMARD use and educational level were associated with subgroup membership. Integrating patient’s medication preferences in pharmacotherapy decisions may improve the quality of decisions and possibly medication adherence.

Original languageEnglish
Pages (from-to)1199-1211
Number of pages13
JournalPatient Preference and Adherence
Publication statusPublished - 22 Jul 2019


  • Discrete choice experiment
  • Disease-modifying antirheumatic drugs
  • Rheumatoid arthritis
  • Treatment preferences


Dive into the research topics of 'Preferences of patients with rheumatoid arthritis regarding disease-modifying antirheumatic drugs: A discrete choice experiment'. Together they form a unique fingerprint.

Cite this