Perceived clinical utility of a test for predicting inadequate response to TNF inhibitor therapies in rheumatoid arthrit
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Rheumatology International https://doi.org/10.1007/s00296-020-04746-7
INTERNATIONAL
OBSERVATIONAL RESEARCH
Perceived clinical utility of a test for predicting inadequate response to TNF inhibitor therapies in rheumatoid arthritis: results from a decision impact study Dimitrios A. Pappas1,2 · Christine Brittle4 · James E. Mossell III3 · Johanna B. Withers5 · Jeraldine Lim‑Harashima5 · Joel M. Kremer2 Received: 17 August 2020 / Accepted: 29 October 2020 © The Author(s) 2020
Abstract Tumor necrosis factor inhibitor (TNFi) therapies are often the first biologic therapy used to treat rheumatoid arthritis (RA) patients. However, a substantial fraction of patients do not respond adequately to TNFi therapies. A test with the ability to predict response would inform therapeutic decision-making and improve clinical and financial outcomes. A 32-question decision-impact survey was conducted with 248 rheumatologists to gauge the perceived clinical utility of a novel test that predicts inadequate response to TNFi therapies in RA patients. Participants were informed about the predictive characteristics of the test and asked to indicate prescribing decisions based on four result scenarios. Overall, rheumatologists had a favorable view of the test: 80.2% agreed that it would improve medical decision-making, 92.3% said it would increase their confidence when making prescribing decisions, and 81.5% said it would be useful when considering TNFi therapies. Rheumatologists would be more likely to prescribe a TNFi therapy when the test reported that no signal of non-response was detected (79.8%) and less likely to prescribe a TNFi therapy when a signal of non-response was detected (11.3%–25.4%). Rheumatologists (84.7%) agreed that payers should provide coverage for such a test. This study shows that rheumatologists support the clinical need for a test to predict inadequate response to TNFi therapies. Test results were perceived to lead to changes in prescribing behaviors as results instill confidence in the ordering rheumatologist. Keywords Arthritis · Rheumatoid · Surveys and questionnaires · Decision-making · Tumor necrosis factor inhibitors · Precision medicine · Predictive value of tests · Therapeutics
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00296-020-04746-7) contains supplementary material, which is available to authorized users.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects about 1.3 million U.S. adults [1]. When RA is not adequately controlled, joint damage and chronic inflammation can lead to permanent disability and poor health outcomes, including shortened life expectancy. Often, multiple
* Dimitrios A. Pappas [email protected]
Joel M. Kremer [email protected]
Christine Brittle [email protected]
1
Corrona LLC, Waltham, MA, USA
James E. Mossell III [email protected]
2
Corrona Research Foundation, Waltham, MA, USA
3
Tift Regional Medical Center, Tifton, GA, US
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