OBJECTIVES: To investigate factors that concern patients with inflammatory arthritis when choosing biological/target synthetic disease-modifying antirheumatic drugs (b/ts DMARDs).

METHODS: With instruction of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we systematically searched for patient-reported factors regarding b/ts DMARDs use from PubMed, Web of Science, Cochrane and Embase. Searched terms included ‘biologics’, ‘inflammatory arthritis’, ‘barrier’, ‘patient-reported’, ‘preference’ and their synonyms between January 1^st 2000 and January 1^st 2022. Content analysis was performed to summarize factors grouped by four themes - social aspects (e.g. knowledge, drug-distribution), clinical aspects (e.g. experience of clinical staff), characteristics of medicine (e.g. safety, efficacy) and financial aspects (e.g. cost, insurance). A heat map was used to illustrate the frequency of each theme reported in three decision making processes: the initiation, choice and discontinuation of b/ts DMARDs.

RESULTS: Among 2261 papers searched, 34 studies comprehensively characterized patient-reported factors in three contexts (initiation: N = 4; preference: N = 21; discontinuation/switch: N = 8; initiation and discontinuation: N = 1). 26 (73.5%) studies focused on patients with rheumatoid arthritis or psoriasis. 91% of the studies were conducted in western countries, whereas there are three studies of China and Japan. Social aspects and characteristics of medicine were the most frequently mentioned factors regarding drug initiation and choice; these two factors were also commonly cited when b/ts DMARDs were abandoned. Financial concerns were less frequently reported throughout the decision-making process.

CONCLUSIONS: Compared to financial concerns and clinical aspects, social aspects and characteristics of medicine were more likely to be considered by patients in decision related to the use of novel DMARDs. This study explored the shift in patient consideration from initiating to discontinuing b/ts DMARDs and informs the ways to improve treatment uptake and compliance by health education for medication use and improved social care support for patients with inflammatory arthritis.