For 51 people with rheumatoid arthritis, the choice was between a daily oral medicine and an injected treatment—and most chose the pill. In a trial led by Floor L. Reimann of Frisius Medical Centre in Leeuwarden, Netherlands, patients who could make that choice reported greater satisfaction with their treatment than patients assigned one of the same options at random.
Rheumatoid arthritis is a long-term disease that causes painful swelling in the joints. When earlier medicines have not worked, doctors may offer biologic treatments that target parts of the immune system. These treatments can work in different ways, and taking a medicine by mouth may feel different from giving oneself an injection. The trial asked whether involving patients in that decision affected how they felt about and continued their care.
The multicenter study included 102 people with rheumatoid arthritis who had not previously used biologic disease-modifying antirheumatic drugs. Participants were randomly placed in one of two groups. One group could choose between filgotinib, an oral Janus kinase inhibitor, and an injected tumor necrosis factor inhibitor. The other group was randomly assigned one of those same treatment options.
Among the 51 people offered a choice, 28—55 percent—selected filgotinib, while 23, or 45 percent, chose the injected treatment. By 24 weeks, treatment satisfaction was significantly higher in the patient-choice group than in the group assigned a treatment. The researchers also found that fewer people in the choice group had switched to a different type of treatment by week 12. The report did not give the number of patients who switched in each group.
Other results pointed in a similar direction, though not all were conclusive. At week 24, the average score for disease activity across 28 joints was lower in the choice group, but the difference was not statistically significant. That means the trial did not establish that the groups truly differed on this measure. At week 12, patients in the randomly assigned group used more glucocorticoids, medicines that reduce inflammation, and had significantly more reported adverse events per patient.
The findings do not show that one of the two drugs is better for everyone. Instead, they suggest that having a say in a treatment decision may improve patients’ experience and help them stay with the approach they start. The study authors wrote that the results underscore the importance of patient participation and shared decision-making. The trial was relatively small, and several authors disclosed ties to the biopharmaceutical industry, details readers should keep in mind when weighing the results.
For people facing a long course of treatment, a conversation about what fits their needs may be a meaningful part of care. Further research can test whether the benefits of choice hold across larger groups and over longer periods. For now, the trial offers a clear reason for clinicians to include patients in decisions when more than one treatment is suitable.