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Peer-reviewedCC BY-NC 4.0RMD Open

Better After CHoosing in rheumatoid arthritis (the BACH trial): patients who have the opportunity to choose their treatment are more satisfied

  • Floor L Reimann1
  • Nic JGM Veeger2,3
  • Annemiek Willemze4
  • Floris A van Gaalen5
  • Letty A Versteeg6
  • Rens Besseling1
  • Inge R Klein1
  • Freke R Wink1
  • Lidy Hendriks1,7
  • Annemarie M Schilder1
  • Tjitske B Berends-De Vries1
  • Dan Zhang1
3 more authors
  • Harald E Vonkeman8,9
  • Thomas WJ Huizinga5
  • Reinhard Bos1,5,7
9 affiliations
  1. 1Department of Rheumatology, Frisius Medical Centre, Leeuwarden, The Netherlands
  2. 2Department of Epidemiology, Frisius Medical Centre, Leeuwarden, The Netherlands
  3. 3Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
  4. 4Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
  5. 5Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  6. 6Department of Rheumatology, Deventer Ziekenhuis, Deventer, The Netherlands
  7. 7Department of Rheumatology, Ziekenhuis Nij Smellinghe, Drachten, The Netherlands
  8. 8Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
  9. 9Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, The Netherlands
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Abstract

Objectives: Shared decision-making is advised to improve patient self-management and engagement in the treatment of rheumatoid arthritis (RA). We evaluated treatment preference and treatment satisfaction of patients with active RA, when personally choosing their subsequent mode of action after failure of conventional disease-modifying antirheumatic drugs (DMARDs). We hypothesised that patient choice would have a positive effect on treatment satisfaction.

Methods: We conducted a multicentre, 24-week, open-label, randomised trial for patients with biologic (DMARD)-naïve RA. 102 patients were randomised 1:1 to either personally choose between subcutaneous tumour necrosis factor inhibitor (TNFi) or oral Janus kinase inhibitor (JAKi) filgotinib or to be randomised 1:1 to the same treatment options.

Results: In the patient-choice group, 55% of patients chose JAKi treatment (n=28) compared with 45% (n=23) who chose subcutaneous TNFi. Treatment satisfaction in the patient-choice group was significantly higher at 24 weeks compared with the randomised group (46 vs 33, p=0.032). By week 12, fewer patients in the patient-choice group than in the randomisation group switched to a different mode of action (6 vs 15, p=0.026). At week 24, the mean Disease Activity Score in 28 joints using erythrocyte sedimentation rate was numerically, but not significantly, lower in the patient-choice group (2.24 vs 2.71, p=0.083). More glucocorticoids were used in the randomised group at week 24 (4 vs 12, p=0.031). The number of adverse events per patient was significantly higher in the randomised group (1.61 vs 2.02, p=0.046).

Conclusions: When allowed to choose freely, 55% of patients with RA chose an oral JAKi and 45% chose a subcutaneous TNFi. Patients who chose their own treatment had higher treatment satisfaction, better drug retention and reported fewer adverse events.

Trial registration number: NCT04985435.

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Cite

BibTeXRIS
BibTeX
@article{reimann2026better,
  title = {{Better After CHoosing in rheumatoid arthritis (the BACH trial): patients who have the opportunity to choose their treatment are more satisfied}},
  author = {Floor L Reimann and Nic JGM Veeger and Annemiek Willemze and Floris A van Gaalen and Letty A Versteeg and Rens Besseling and Inge R Klein and Freke R Wink and Lidy Hendriks and Annemarie M Schilder and Tjitske B Berends-De Vries and Dan Zhang and Harald E Vonkeman and Thomas WJ Huizinga and Reinhard Bos},
  journal = {RMD Open},
  year = {2026},
  month = oct,
  doi = {10.1136/rmdopen-2026-007406},
  url = {https://doi.org/10.1136/rmdopen-2026-007406},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Better After CHoosing in rheumatoid arthritis (the BACH trial): patients who have the opportunity to choose their treatment are more satisfied
AU  - Floor L Reimann
AU  - Nic JGM Veeger
AU  - Annemiek Willemze
AU  - Floris A van Gaalen
AU  - Letty A Versteeg
AU  - Rens Besseling
AU  - Inge R Klein
AU  - Freke R Wink
AU  - Lidy Hendriks
AU  - Annemarie M Schilder
AU  - Tjitske B Berends-De Vries
AU  - Dan Zhang
AU  - Harald E Vonkeman
AU  - Thomas WJ Huizinga
AU  - Reinhard Bos
PY  - 2026
DA  - 2026/10/27
JO  - RMD Open
DO  - 10.1136/rmdopen-2026-007406
UR  - https://doi.org/10.1136/rmdopen-2026-007406
AB  - Objectives: Shared decision-making is advised to improve patient self-management and engagement in the treatment of rheumatoid arthritis (RA). We evaluated treatment preference and treatment satisfaction of patients with active RA, when personally choosing their subsequent mode of action after failure of conventional disease-modifying antirheumatic drugs (DMARDs). We hypothesised that patient choice would have a positive effect on treatment satisfaction.  Methods: We conducted a multicentre, 24-week, open-label, randomised trial for patients with biologic (DMARD)-naïve RA. 102 patients were randomised 1:1 to either personally choose between subcutaneous tumour necrosis factor inhibitor (TNFi) or oral Janus kinase inhibitor (JAKi) filgotinib or to be randomised 1:1 to the same treatment options.  Results: In the patient-choice group, 55% of patients chose JAKi treatment (n=28) compared with 45% (n=23) who chose subcutaneous TNFi. Treatment satisfaction in the patient-choice group was significantly higher at 24 weeks compared with the randomised group (46 vs 33, p=0.032). By week 12, fewer patients in the patient-choice group than in the randomisation group switched to a different mode of action (6 vs 15, p=0.026). At week 24, the mean Disease Activity Score in 28 joints using erythrocyte sedimentation rate was numerically, but not significantly, lower in the patient-choice group (2.24 vs 2.71, p=0.083). More glucocorticoids were used in the randomised group at week 24 (4 vs 12, p=0.031). The number of adverse events per patient was significantly higher in the randomised group (1.61 vs 2.02, p=0.046).  Conclusions: When allowed to choose freely, 55% of patients with RA chose an oral JAKi and 45% chose a subcutaneous TNFi. Patients who chose their own treatment had higher treatment satisfaction, better drug retention and reported fewer adverse events.  Trial registration number: NCT04985435.
SN  - 2056-5933
ER  -