{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T18:44:58Z","timestamp":1776105898891,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,6]],"date-time":"2018-11-06T00:00:00Z","timestamp":1541462400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Southmead Hospital Charity: Research Fund","award":["3898"],"award-info":[{"award-number":["3898"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Musculoskeletal Care"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Successful biologic disease\u2010modifying anti\u2010rheumatic drug (bDMARD) dose reduction appears increasingly possible from clinical trials. The present study aimed to understand the patient perspective of bDMARD dose reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis who were self\u2010administering subcutaneous bDMARDs therapy at two National Health Service trusts participated in semi\u2010structured interviews. To capture multiple experiences, patients were purposefully sampled for a range of age, gender, disease duration, reducing\/not reducing bDMARDs and either within 3\u201312\u00a0months of bDMARD initiation or \u226512\u00a0months and in remission\/low disease activity. Inductive thematic analysis was utilized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen patients were interviewed (six on dose reduction). Five overarching themes were identified. When thinking about dose reduction, patients reflected on their difficult life before bDMARDs (\u201cWhere I was then\u201d) compared with their transformative effects (\u201cWhere I am now\u201d). All raised concerns that a dose reduction would take them back to where they used to be (\u201cFears for the future\u201d) and most believed it to be a cost\u2010cutting exercise. Most had \u201cHopes for the future\u201d, that a reduction would lower their risk of side effects, and release funds for other patients. They wanted a clear rationale for reduction, collaborative decision making, and control over flexible dosing (\u201cInformation needs\u201d).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients were fearful of reducing the dose of their bDMARDs, having previously experienced uncontrollable symptoms. However, most were willing to try, provided that there was a clear rationale and that it was in their best interests, with opportunities for collaboration and dose control. These patient perspectives will inform the provision of patient information to guide clinical discussions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/msc.1367","type":"journal-article","created":{"date-parts":[[2018,11,6]],"date-time":"2018-11-06T09:14:02Z","timestamp":1541495642000},"page":"63-71","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Dose reduction of biologic therapy in inflammatory arthritis: A qualitative study of patients' perceptions and needs"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7851-2039","authenticated-orcid":false,"given":"Sarah","family":"Hewlett","sequence":"first","affiliation":[{"name":"Department of Nursing University of the West of England Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Haig\u2010Ferguson","sequence":"additional","affiliation":[{"name":"Department of Nursing University of the West of England Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Rose\u2010Parfitt","sequence":"additional","affiliation":[{"name":"Rheumatology Unit North Bristol NHS Trust Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0737-8255","authenticated-orcid":false,"given":"Serena","family":"Halls","sequence":"additional","affiliation":[{"name":"Department of Nursing University of the West of England Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Freke","sequence":"additional","affiliation":[{"name":"Rheumatology Unit North Bristol NHS Trust Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Creamer","sequence":"additional","affiliation":[{"name":"Rheumatology Unit North Bristol NHS Trust Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew464"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew269"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780230202"},{"key":"e_1_2_8_6_1","first-page":"2286","article-title":"A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index","volume":"21","author":"Garrett S.","year":"1994","journal-title":"Journal of Rheumatology"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.142901"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X05279903"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212423"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key208"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kex315"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh237"},{"issue":"2","key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1136\/annrheumdis-2015-eular.1641","article-title":"Patient reported reasons for refraining from participation in dose reduction studies with biologics","volume":"74","author":"Marsman A.","year":"2015","journal-title":"Annals of the Rheumatic Diseases"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.126573"},{"key":"e_1_2_8_15_1","unstructured":"National Institute for Health and Care Excellence (NICE) technology appraisal guidance(2010a).Adalimumab etanercept infliximab rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor. Guidance TA195. Retrieved fromhttps:\/\/www.nice.org.uk\/guidance\/ta195"},{"key":"e_1_2_8_16_1","unstructured":"National Institute for Health and Care Excellence (NICE) technology appraisal guidance(2010b).Etanercept infliximab and adalimumab for the treatment of psoriatic arthritis. Guidance TA199. Retrieved fromhttps:\/\/www.nice.org.uk\/guidance\/ta199"},{"key":"e_1_2_8_17_1","unstructured":"National Institute for Health and Care Excellence (NICE) technology appraisal guidance(2016a).Adalimumab etanercept infliximab certolizumab pegol golimumab tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed. Guidance TA375. Retrieved fromhttps:\/\/www.nice.org.uk\/guidance\/ta375"},{"key":"e_1_2_8_18_1","unstructured":"National Institute for Health and Care Excellence (NICE) technology appraisal guidance(2016b).TNF\u2010alpha inhibitors for ankylosing spondylitis and non\u2010radiographic axial spondyloarthritis. Guidance TA383. Retrieved fromhttps:\/\/www.nice.org.uk\/guidance\/ta383"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew033"},{"key":"e_1_2_8_20_1","volume-title":"Qualitative research practice. A guide for social science students and researchers","author":"Ritchie J.","year":"2003"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/msc.149"},{"issue":"4","key":"e_1_2_8_22_1","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD001431.pub5","article-title":"Decision aids for people facing health treatment or screening decisions","author":"Stacey D.","year":"2017","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200104)45:2<111::AID-ANR162>3.0.CO;2-E"},{"key":"e_1_2_8_24_1","first-page":"579","article-title":"Development of a disease activity score based on judgement in clinical practice by rheumatologist","volume":"20","author":"Heijde D. 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