US Researchers have identified key differences in the way African-American and White rheumatoid arthritis (RA) patients evaluate treatment options.
“We found that African–American patients attach greater importance to the risks of toxicity (particularly for serious, albeit rare, adverse events) and less importance to the likelihood of benefit than their White counterparts,” report Liana Fraenkel (Yale University, New Haven, Connecticut) and co-workers in the journal Arthritis Care and Research.
Overall, 136 RA patients (49% African–American, 51% White) completed a computer survey investigating their approach to specific risks (injection reaction, nausea, liver or lung injury, tuberculosis, neurologic disease, and theoretical risk for cancer) and benefits (remission, symptom improvement, and prevention of radiographic progression) associated with different disease-modifying anti-rheumatic drugs (DMARDs).
“Because results were based solely on trade-offs between treatment characteristics, the relative importance data were not biased by physicians' preferences or previously formed opinions based on external sources of information,” emphasize Fraenkel et al.
Analysis revealed that while African–American patients assigned the greatest importance to the theoretical risk for cancer with DMARDs, White patients placed the likelihood for remission or preventing radiographic progression as the most important factor in evaluating treatment options.
When the ratio of importance patients assigned to benefit versus risk were calculated, 52% of African–American patients scored less than 1 and were classified as being risk averse, compared with just 12% of White patients.
African–American patients were significantly more likely than White patients to be risk averse, even after adjusting for confounding factors such as marital status, educational attainment, and income (odds ratio=8.4).
“Given these results, physicians should confirm that patients have accurate expectations regarding the natural history and treatment of their disease, and ensure that patient preferences are based on an informed assessment of the pros and cons related to available treatment options,” Fraenkel et al recommend.
“Improved awareness and understanding of how RA patients weigh treatment risks and benefits will hopefully improve uptake, adherence, and outcomes.”