Exploring the perspective of patients with immune-mediated inflammatory diseases and care providers on the use of immunomodulatory drugs in infections: an interview study. Issue 1 (11th January 2023)

• Record Type: Journal Article
• Authors: Opdam, Merel A A; Vriezekolk, Johanna E; Broen, J; den Broeder, Alfons A; Verhoef, Lise M
• Is Part Of: Rheumatology advances in practice. Volume 7:Issue 1(2023)
• Publication Date: 2023-01-11
• Subjects: RA -- PsA -- SpA -- infections -- immunomodulatory agents -- qualitative research; Rheumatology -- Periodicals; Rheumatology; Rheumatic Diseases; Rheumatology; Periodicals; Electronic journals; Periodical; 616.723005
• DOI: 10.1093/rap/rkad003
• Languages: English
• ISSNs: 2514-1775

Abstract

Abstract: Objectives: Immunomodulatory agents are safe and effective as treatment for various immune-mediated inflammatory diseases (IMIDs), but are associated with a slightly increased infection risk. It is uncertain whether, in the event of an infection, continuation or temporary interruption of immunomodulatory agents leads to better outcomes. Owing to this uncertainty, it is of importance to explore the perspectives of health-care providers (HCPs) and patients on this topic. In this study, we set out to identify and provide an overview of reasons for both treatment strategies. Methods: Semi-structured interviews were conducted with HCPs involved in the pharmacological treatment of IMIDs and with IMID patients using one or more immunomodulatory agent. Purposive sampling was used to enrich data variation. Interviews were conducted until data saturation was reached and subsequently analysed using qualitative content analysis. Results: In total, 13 HCPs and 19 IMID patients were interviewed. A wide range of reasons for both treatment strategies were identified, categorized into 10 overarching themes, including IMID characteristics, infection characteristics and the patient–HCP relationship. Conclusion: In this interview study, we identified various reasons for continuation or temporary interruption of immunomodulatory agents during infections for both IMID patients and HCPs. We found overlapping themes, such as IMID characteristics; however, the content and interpretation of these themes might differ between HCPs and patients. Both HCPs and patients mentioned that the decision for a treatment strategy is often about weighing benefits against risks (e.g. infection severity vs disease flare). Lay Summary: What does this mean for patients? People with an immune-mediated inflammatory disease, such as rheumatoid arthritis, often use medication that affects their immune system (immunomodulatory medication). The immune system is involved in these diseases but is also needed to control infections (such as influenza or urinary tract infections). Consequently, immunomodulatory medication can also affect the way in which the immune system responds to such infections. When an infection occurs, it can be difficult to decide whether this medication should be continued or temporarily interrupted. We wanted to study what patients and health-care providers think about this and why they would decide either to continue or temporarily to interrupt the immunomodulatory medication during an infection. We interviewed patients and health-care providers about the factors that contribute to this decision. These interviews resulted in 10 themes that play a role in the decision-making process. Examples of these themes are disease (including disease activity) and infection characteristics (including the severity of the infection). We conclude that the decision for a treatment strategy is often about weighing benefits against risks (e.g. infection severity vs disease flare). In clinical practice, health-care providers could use these themes as a tool when deciding, together with a patient, what to do during an infection.