Treatment for rheumatoid arthritis (RA) has advanced greatly over the last 20 years with the incorporation of biologic therapies to the therapeutic arsenal the rheumatologist has at his or her disposal. Initial biologic intravenous (IV) treatments led to a large number of subcutaneous (SC) drugs, and in recent years new non biologic oral drugs have come onto the market. Up until now the patient had little say regarding the ideal administration route, but this has recently changed.1–3 Patient opinion is increasingly more important in choosing the mechanism of action of a biologic, and also its form of administration.4

In order to determine the current opinion of a sample of patients with rheumatoid arthritis (RA) attended in our centre all patients with RA who used the rheumatology service were successfully selected for 2 weeks. Each patient was asked 3 questions by the nursing staff (day hospital and biologic therapy unit) or by their regular rheumatologist (outpatient consultations). The administration route of the current treatment of each patient was also recorded, forming patient groups with oral administration (only oral treatment), subcutaneous administration (subcutaneous treatment with or without oral treatment) and intravenous treatment (with or without oral treatment). The first question was: what is the ideal administration route for you in a RA treatment? The second was: Why did you choose this administration route? And the last was: did you at any time talk about the administration route with the rheumatologist in charge of your treatment? Response options patients could give for the first questions were 3, oral, subcutaneous or intravenous administration route and for the third question were 2, yes or no. The second question allowed for more of an open response which was summarised in the options contained in Table 1. Those patients who had responded to the questions in the day hospital or the functional unit of biologics were excluded when they were attended by outpatient departments.

Overall patient responses are contained in Table 1. The patients with oral treatment received methotrexate (7 patients) leflunomide (4 patients) and azathioprine (one patient); the patients with subcutaneous treatment received etanercept (6 patients), adalimumab (4 patients), golimumab (4 patients), certolizumab (2 patients), abatacept (one patient), tocilizumab (3 patients) and methotrexate (4 patients); and the patients with intravenous treatment received infliximab (23 patients), tocilizumab (18 patients), rituximab (11 patients) and abatacept (5 patients). Those patients with oral treatments were content with the oral administration route (10/12), whilst the majority of patients in SC treatment would have preferred an oral drug (16/24 patients) due to its convenience (69%). With regard to the patients treated with intravenous therapies, surprisingly, the majority (44/57) preferred the IV route, in contrast to that expressed in several published studies.2 The good relationship with the nurse and the broad experience of some of the patients with the day hospital could be factors implicated in these results. Even so, almost a quarter of the patients preferred an oral or SC treatment.

In a similar study, presented at an international congress, which included 41 patients with RA, over half of them (53%) indicated that oral administration was ideal and 34% SC administration.5 There is a great difference with our sample since only 25% of patients had biologic treatments (IV or SC). However, the majority of patients included in this study and of our patients with SC tended to choose the oral route as the ideal one for its convenience.

Almost half of our patients responded that they preferred the intravenous route, but the majority were patients who were currently receiving IV treatment (only 2 patients who were not currently receiving IV treatment preferred this administration route). The most commonly given reasons for this were the efficacy (18/44) and safety (15/44) of the IV treatment.

Communication between physician and patient is key when choosing the appropriate treatment and it is notable that over half of our patients said they had not previously spoken about this aspect of their treatment with the rheumatologist in charge of their treatment. Although this result may only apply to our centre, it highlights the importance of involving patients in all aspects of their treatment.

The patient's opinion when choosing administration route is important. Although the intravenous route is initially rejected by the majority of patients, once established many of them agree to maintaining intravenous treatment due to the higher perceived sensation of efficacy and safety. The subcutaneous route, however, although greatly increased in recent years is not the preferred route by many patients, who would mostly choose oral treatments.