An international multicentre analysis of current prescribing practices and shared decision-making in psoriatic arthritis

Watson, Lily, Coyle, Conor, Whately-Smith, Caroline, Brooke, Melanie, Kiltz, Uta, Lubrano, Ennio, Queiro, Rubén, Trigos, David, Brandt-Juergens, Jan, Choy, Ernest ORCID: https://orcid.org/0000-0003-4459-8609, D'Angelo, Salvatore, Delle Sedie, Andrea, Dernis, Emmanuelle, Guis, Sandrine, Helliwell, Philip, Ho, Pauline, Hueber, Axel J., Joven, Beatriz, Koehm, Michaela, Montilla, Carlos, Packham, Jon, Pinto Tasende, José Antonio, Ramirez Garcia, Felipe Julio, Ruyssen-Witrand, Adeline, Scrivo, Rossana, Twigg, Sarah, Soubrier, Martin, Wirth, Théo, Gossec, Laure and Coates, Laura C. 2023. An international multicentre analysis of current prescribing practices and shared decision-making in psoriatic arthritis. Rheumatology 10.1093/rheumatology/kead621

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Abstract

Objectives Shared decision-making (SDM) is advocated to improve patient outcomes in PsA. We analysed current prescribing practices and the extent of SDM in PsA across Europe. Methods The ASSIST study was a cross-sectional observational study of PsA patients ≥18 years of age attending face-to-face appointments between July 2021 and March 2022. Patient demographics, current treatment and treatment decisions were recorded. SDM was measured by the clinician’s effort to collaborate (CollaboRATE questionnaire) and patient communication confidence (PEPPI-5 tool). Results A total of 503 patients were included from 24 centres across the UK, France, Germany, Italy and Spain. Physician- and patient-reported measures of disease activity were highest in the UK. Conventional synthetic DMARDs constituted a higher percentage of current PsA treatment in the UK than continental Europe (66.4% vs 44.9%), which differed from biologic DMARDs (36.4% vs 64.4%). Implementing treatment escalation was most common in the UK. CollaboRATE and PEPPI-5 scores were high across centres. Of 31 patients with low CollaboRATE scores (<4.5), no patients with low PsAID-12 scores (<5) had treatment escalation. However, of 465 patients with CollaboRATE scores ≥4.5, 59 patients with low PsAID-12 scores received treatment escalation. Conclusions Higher rates of treatment escalation seen in the UK may be explained by higher disease activity and a younger cohort. High levels of collaboration in face-to-face PsA consultations suggests effective implementation of the SDM approach. Our data indicate that in patients with mild disease activity, only those with higher perceived collaboration underwent treatment escalation. Prospective studies should examine the impact of SDM on PsA patient outcomes.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Medicine
Publisher:	Oxford University Press
ISSN:	14620324
Date of First Compliant Deposit:	19 January 2024
Date of Acceptance:	27 October 2023
Last Modified:	19 Jan 2024 17:24
URI:	https://orca.cardiff.ac.uk/id/eprint/165690

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