Patient and Rheumatologist Perspectives on Tapering DMARDs in Rheumatoid Arthritis: A Qualitative Study

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dc.contributor.authorHazlewood, Glen S
dc.contributor.authorLoyola-Sanchez, Adalberto
dc.contributor.authorBykerk, Vivian
dc.contributor.authorHull, Pauline M
dc.contributor.authorMarshall, Deborah
dc.contributor.authorPham, Tram
dc.contributor.authorBarber, Claire E H
dc.contributor.authorBarnabe, Cheryl
dc.contributor.authorSirois, Alexandra
dc.contributor.authorPope, Janet
dc.contributor.authorSchieir, Orit
dc.contributor.authorRichards, Dawn
dc.contributor.authorProulx, Laurie
dc.contributor.authorBartlett, Susan J
dc.date.accessioned2022-01-03T20:57:38Z
dc.date.available2022-01-03T20:57:38Z
dc.date.issued2021-04-20
dc.description.abstractObjectives: To understand the perspectives of patients and rheumatologists for tapering DMARDs in RA. Methods: Using semi-structured interview guides, we conducted individual interviews and focus groups with RA patients and rheumatologists, which were audiotaped and transcribed. We conducted a pragmatic thematic analysis to identify major themes, comparing and contrasting different views on DMARD tapering between patients and rheumatologists. Results: We recruited 28 adult patients with RA (64% women; disease duration 1-54 years) and 23 rheumatologists (52% women). Attitudes across both groups towards tapering DMARDs were ambivalent, ranging from wary to enthusiastic. Both groups expressed concerns, particularly the inability to ‘recapture’ the same level of disease control, while also acknowledging potential positive outcomes such as reduced drug harms. Patient tapering perspectives (whether to and when) changed over time and commonly included non-biologic DMARDs. Patient preferences were influenced by lived experiences, side effects, previous tapering experiences, disease trajectory, remission duration, and current life roles. Rheumatologists’ perspectives varied on timing and patient profile to initiate tapering, and were informed by both data and clinical experience. Patients expressed interest in shared decision making (SDM) and close monitoring during tapering, with ready access to their healthcare team if problems arose. Rheumatologists were generally open to tapering (not stopping), though sometimes only when requested by their patients. Conclusion: The perspectives of patients and rheumatologists on tapering DMARDs in RA vary and evolve over time. Rheumatologists should periodically discuss DMARD tapering with patients as part of SDM, and ensure monitoring and flare management plans are in place.en_US
dc.description.grantingagencyCanadian Institutes of Health Research (CIHR)en_US
dc.identifier.citationGlen S Hazlewood, Adalberto Loyola-Sanchez, Vivian Bykerk, Pauline M Hull, Deborah Marshall, Tram Pham, Claire E H Barber, Cheryl Barnabe, Alexandra Sirois, Janet Pope, Orit Schieir, Dawn Richards, Laurie Proulx, Susan J Bartlett, Corrigendum to: Patient and Rheumatologist Perspectives on Tapering DMARDs in Rheumatoid Arthritis: A Qualitative Study, Rheumatology, Volume 60, Issue 11, November 2021, Page 5484, https://doi.org/10.1093/rheumatology/keab482en_US
dc.identifier.doihttp://dx.doi.org/10.1093/rheumatology/keab330en_US
dc.identifier.grantnumberFRN 156267 and FRN 151608en_US
dc.identifier.urihttp://hdl.handle.net/1880/114245
dc.language.isoengen_US
dc.publisherBritish Society for Rheumatology, Oxford University Press [University Publisheren_US
dc.publisher.departmentMedicineen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.hasversionacceptedVersionen_US
dc.publisher.institutionUniversity of Calgaryen_US
dc.publisher.policyhttps://academic.oup.com/journals/pages/access_purchase/rights_and_permissions/author_self_archiving_policyen_US
dc.subjectrheumatoid arthritisen_US
dc.subjecttaperingen_US
dc.subjectqualitativeen_US
dc.subjectDMARDen_US
dc.subjectreductionen_US
dc.subjectpatient perspectiveen_US
dc.subjectpatient preferenceen_US
dc.titlePatient and Rheumatologist Perspectives on Tapering DMARDs in Rheumatoid Arthritis: A Qualitative Studyen_US
dc.typejournal articleen_US
ucalgary.item.requestcopytrueen_US
ucalgary.scholar.levelFacultyen_US
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