OBJECTIVES: To understand the triggers for treatment switches and perception of physician interactions among patients with rheumatoid arthritis (RA) in the U.S, using patient and caregiver conversations online.

METHODS: Two-year historical, public, anonymized, U.S.-specific discussions in English about RA were pulled from online forums and social networks. The data were cleansed to focus on the voice of the patient, providing 170,000 unique data points, with references to 15 of the top RA medication brands. A set of proprietary taxonomies was applied to obtain over 15,000 references relating to treatment switching. These data were analyzed to evaluate the associations with drug class (biologic or conventional disease-modifying anti-rheumatic drugs, JAK Inhibitors) and individual brands. The specific factors driving patients to switch treatment were identified and quantified. Patient perception of physician interactions was also analyzed.

RESULTS: The two top triggers driving patients’ treatment switching decisions were perception of efficacy (including quality of life [QoL], i.e. physical independence and performing daily activities, which are considered key QoL measures by patients) and safety. Other triggers included physician influence, route of administration, or pregnancy-related concerns. Efficacy and safety concerns were the two key factors in discontinuation decisions, with efficacy alone the most frequent determinant for switching to a treatment: 48% of patients mentioned the QoL aspect of efficacy as the trigger behind switching medication. Physician influence appears low, with 27% of comments reporting that advice was not followed, 18% reporting confusion about advice received, and over 60% of reported physician experiences being negative.

CONCLUSIONS: Unsolicited and self-reported triggers for treatment switches and perception of physician interactions in U.S. patients with RA through the collection of online forum discussions may improve the understanding of patients’ perceptions and needs, and aid in supporting stakeholder communication to better manage RA and improve health outcomes.