Source:
Patients Prefer Initial Combination Therapy With Infliximab for Rheumatoid Arthritis
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD
Release Date: June 29, 2007
CME credits available1
Study and Findings
This article discusses the retrospective study of 440 patients who completed a questionnaire exploring their likes and dislikes regarding treatment of rheumatoid arthritis,2 which concluded, “Patients prefer combination therapy with infliximab for initial treatment of rheumatoid arthritis.”
The pragmatic implications of the study are contained in this excerpt:
The BeSt study demonstrated that initial combination therapy including either prednisone or infliximab was associated with earlier clinical response and less radiographic damage after 1 year vs sequential monotherapy or step-up combination therapy in the treatment of rheumatoid arthritis. The current study suggests that patients with rheumatoid arthritis might prefer taking infliximab and dislike taking prednisone.
Commentary
While the primary results of the study are both interesting and important, I wish to focus on the one specific, almost incidental observation pertinent to patient compliance in this quotation from the article:
This result is an exemplar of a general principle of patient compliance that is simple and fundamental but often overlooked:
Certainly a patient’s preferences should be taken into account. Nor should the other factors that may influence compliance, such as side-effects, be ignored.
One cannot, however, casually assume that “it’s common sense” that patients are more likely to comply with the latest and greatest – and most expensive – format of a medication because, as pharmaceutical ads and research proposals routinely declare, it requires only once daily dosing or lacks a specific side-effect.
Nor can identification of high quality patient-clinician communication or a patient’s belief that he or she will take a specific medication be assumed to be predictive of compliance.
The only valid measure of patient compliance is measuring patient compliance.
Kudos to the researchers on this study for asking the right questions and measuring the right values.
Footnotes
