Knee OA patients prefer safer, albeit less effective, treatments

[Guest guest]

Knee OA patients prefer safer, albeit less effective, treatments

Rheumawire

Jul 5, 2004

Mann

New Haven, CT - Many older patients with knee osteoarthritis (OA) opt

for less effective treatments with lower risks of adverse effects over

their more effective, but also more toxic, alternatives, according to a

report in June 28, 2004 issue of the Archives of Internal Medicine [1].

The study, which compiled interviews with 100 patients with symptomatic

knee OA about their medication preferences, found that 44% of patients

preferred topical capsaicinassuming they were responsible for full cost

of the medication. COX-2 inhibitorswhich are described as being 3 times

as effective as capsaicinwere preferred when they cost $10 per month

(the typical copayment for insured patients). Of the cohort, 79% of

patients were female and 92% were white and they had an average age of

70 years.

Conflicting with the current widespread use of nonselective nonsteroidal

anti-inflammatory drugs (NSAIDs) in older patients with arthritis, such

NSAIDs were the least-preferred option across almost all circumstances,

the study showed.

" We conclude that many older patients with knee OA might be willing to

accept less effective treatments in exchange for a lower risk of adverse

effects, " write study authors, led by Dr Liana Fraenkel (Veterans

Affairs Connecticut System, West Haven). " The magnitude of the

discrepancy between patient preferences in this study and the widespread

use of nonselective NSAIDs raises important questions about how patient

preferences are elicited and how treatment decisions for OA are made in

clinical practice. "

" Patients' preferences vary widely, " Fraenkel tells rheumawire. " It's

important to inform patients of all available treatment options and to

formulate treatment plans based on individual patient values. "

Of the medication traits studied, risk of common adverse side effects

(19%) and gastrointestinal ulcer (19%) had the greatest impact on

patient choice. " This suggests that patients' treatment preferences are

driven predominantly by a desire to avoid both common, bothersome side

effects as well as less frequent, but potentially more serious

drug-related toxic effects, " Fraenkel et al write. " The risk of adverse

effects had the strongest impact on patient decision making, which

explains why patients with knee OA almost never preferred nonselective

NSAIDS in this study. "

To arrive at their findings, Fraenkel et al surveyed the importance of

type of drug (prescription or over the counter), administration (dose

and method), time to benefit, response rate, common adverse effects,

risk of ulcer, and monthly copayments. Next, they measured the impact of

these characteristics on the percentage of patients preferring COX-2

inhibitors, glucosamine and/or chondroitin sulfate, opioid derivatives,

and/or capsaicin.

" We were surprised that many patients would opt for safer but less

effective medications, " Fraenkel says. " The study has reminded me not to

presume to know what is important to each individual patient. "

Patients should " talk to their doctor and find out all about the

treatment options available to them [and] be an active participant in

their healthcare, " she says.

Dr Harry Fischer (Beth Israel Medical Center, New York City, NY) tells

rheumawire: " The authors found that patients prefer medications/options

that are less likely to cause adverse effects even if they are less

efficacious. A topical medication [capsaicin] with few or no side

effects appear to be most preferred while nonselective COX-2 inhibitors,

which are the most prescribed for this condition, seem to be least

preferred. "

He adds, " Selective COX-2 inhibitors, which appear to have less

gastrointestinal complications, are preferred over the topicals only if

costs are low and efficacy is high. "

Source

Fraenkel L, Bogardus ST Jr, Concato J, Wittink DR.

Treatment options in knee osteoarthritis: the patient's perspective.

Arch Intern Med 2004 Jun 28; 164(12):1299-304.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org