TY - JOUR T1 - What drives the decision to optimise biological treatment in children and youngsters with juvenile idiopathic arthritis? A discrete-choice experiment JO - Reumatología Clínica (English Edition) T2 - AU - Murias,Sara AU - Boteanu,Alina AU - Calvo,Inmaculada AU - Nuñez,Esmeralda AU - Bravo,Beatriz AU - Bustabad,Sagrario AU - Camacho,Marisol AU - Clemente,Daniel AU - Graña,Jenaro AU - de Inocencio,Jaime AU - Lacruz,Lucía AU - Mesa-del-Castillo,Pablo AU - Nieto-González,Juan Carlos AU - Pinedo,María del Carmen AU - Quesada,Estefanía AU - Vargas,Carmen AU - Antón,Jordi SN - 21735743 M3 - 10.1016/j.reumae.2022.11.002 DO - 10.1016/j.reumae.2022.11.002 UR - https://www.reumatologiaclinica.org/en-what-drives-decision-optimise-biological-articulo-S2173574322001824 AB - ObjectiveTo analyse factors involved in the decision to optimise biologics in juvenile idiopathic arthritis. MethodsA “discrete-choice” methodology was used. In a nominal group meeting, factors which may influence physicians’ decisions to optimise biological dose were identified, together with decision nodes. 1000Minds® was used to create multiple fictitious clinical scenarios based on the factors identified, and to deploy surveys that were sent to a panel of experts. These experts decided for each item which of two clinical scenarios prompted them to optimise the dose of biologic. A conjoint analysis was carried out, and the partial-value functions and the weights of relative importance calculated. ResultsIn the nominal group, three decision nodes were identified: (1) time to decide; (2) to maintain/reduce or prolong interval; (3) what drug to reduce. The factors elicited were different for each node and included patient and drug attributes. The presence of macrophage activation syndrome (MAS), systemic involvement, or subclinical inflammation made the decision easier (highest weights). The presence of joints of difficult control and year of debut influenced the decision in some but not all, and in different directions. Immunogenicity, adherence, and concomitant treatments were also aspects taken into account. ConclusionsThe decision to optimise the dose of biological therapy in children and youngster can be divided into several nodes, and the factors, both patient and therapy-related, leading to the decision can be detailed. These decisions taken by experts may be transported to practice, study designs, and guidelines. ER -