P-082 - Preferences and Experiences of Over-the-Counter Analgesics for Osteoarthritis Signs and Symptoms

Abstract Title: Preferences and Experiences of Over-the-Counter Analgesics for Osteoarthritis Signs and Symptoms


Background: Osteoarthritis (OA), the most common form of arthritis, affects over 32 million Americans¹. Current treatments focus on symptom management through pharmacological and non-pharmacological means, as there is no cure for OA². Patient response to treatment varies greatly, and there is a large component of trial and error in selecting the most effective treatment approach, much of which is undocumented formally. Topical or oral analgesics and anti-inflammation medications are part of the current pharmacological treatment options³.Therefore, it is important to understand general preferences and experiences in using pain medications to relieve OA-related signs and symptoms and enable more comprehensive/holistic recommendations that consider the individual needs and experiences.

Purpose/Objectives: Primary

Objectives:

1. To describe patients’ preferences when choosing medications for the successful management of OA pain.


2. To estimate the extent to which clinical, symptomatic, functional, personal, and environmental characteristics associate with the pattern of use of OA pain medications (used alone or in combination with other medications).

Secondary

Objectives:

1. To determine the relative importance of treatment attributes in the patient preference when choosing medications for the successful management of OA pain.


2. To determine the extent to which patients’ experiences with OA affect their medication use (including acetaminophen) to manage their pain and other symptoms.


3. To describe the aspects associated with medication preferences that patients describe, such as the benefits experienced, what aspects of the treatment experience they prefer and whether it resolved their OA symptoms.

Methods: This study followed a three phased approach. The first two phases included a literature review and in-depth qualitative interviews of participants with OA, to inform the development of the quantitative survey (Phase 3). Using these findings, a conceptual model of medication use patterns was developed. These patterns were then analyzed across two time points to understand changes and consistencies.



The quantitative phase entailed a longitudinal survey at baseline and 4-month follow-up. The survey remained open in the summer season and the winter season to evaluate the impact of seasonal changes on participants’ preferences and medication use patterns.



The survey incorporated a discrete-choice experiment (DCE) that presented participants with hypothetical OA pain medication profiles to quantify preference weights and confidence intervals for established treatment attributes. There was also an experience section to capture participants’ medication use patterns. The DCE data was analyzed using mixed logit regression models.



Eligible participants included adults in the US diagnosed with mild to moderate osteoarthritis, who regularly used OTC pain or anti-inflammatory medications over the past six months. Exclusion criteria included candidacy for joint replacement, other arthritis types, or related conditions, and an inability to consent or understand English.


Results: The study included 1,005 participants, predominantly White (77%) and female (72.1%), with an average age of 59 years (±28). The follow-up survey included 628 of the original participants, resulting in a response rate exceeding 60% over 4 months. Since the cohorts at baseline and follow-up did not significantly differ, only results from the baseline are reported here.



Of the 1,005 participants, 46.9% reported moderate OA, 33.5% reported mild OA, 10.5% severe OA, and 9.1% minor OA, primarily affecting the knee (39%), with pain as the most common symptom (96.1%). Long-term osteoarthritis symptoms, experienced for over five years, were reported by 50%.

Medication Preferences (hypothetical medication scenarios)

Based on the DCE analyses, the following list shows the attributes in order of relative importance (all p-values < 0.001)

< ![if !supportLists] >1. < ![endif] >Quick-relief medications, reducing symptoms in under 15 minutes,

< ![if !supportLists] >2. < ![endif] >Medications addressing multiple symptoms, ache/pain stiffness and range of motion in joints (e.g., shoulder/elbow), inflammation/swelling (over medication addressing ache/pain only),

< ![if !supportLists] >3. < ![endif] >Medications that reduce symptoms to a barely noticeable level,

< ![if !supportLists] >4. < ![endif] >Economically priced medications, specifically under $10,

< ![if !supportLists] >5. < ![endif] >Ingestible medications (over topicals),

< ![if !supportLists] >6. < ![endif] >Medications that are taken less frequently (once or twice a day).



When exploring whether seasonal variations affecting participants' medication attribute preferences, we observed only slight variations, reflecting stable preferences over two seasons.

Medication Use Patterns (actual medication use patterns)

Most participants (73.1%) used multiple medications including both oral and topical. This preference for combining medication types likely reflects the need to address the spectrum of OA symptoms. Among those using multiple medications, most reported symptoms were pain (97.3%), stiffness (88.4%), achiness (80.1%), range of motion limitation (72.0%), inflammation (63.5%), and swelling (53.5%).

Of the oral OTC medications, ibuprofen (26.3%) and acetaminophen (21.4%) were the most used ones, while diclofenac was the preferred topical option (13.9%). Most medications were used on an as-needed basis (61.7%).

When exploring the seasonal effect on participants' medication use patterns, no significant shifts were observed across both seasons.

Conclusions/Implications for future research and/or clinical care: This study's robust longitudinal design highlighted medication use patterns among osteoarthritis sufferers emphasizing a strong preference for medications that offer rapid relief and tackle multiple symptoms. While inflammation is the physiological root of pain, stiffness, swelling, and mobility reduction, these symptoms are perceived differently by participants. Participants prioritized medications that addressed directly observable symptoms, such as stiffness and range of motion, over inflammation and swelling. Additionally, participants indicated humidity and temperature changes affect their OA symptoms, however, the data shows no changes in the medication choices and use frequency. While participants in the DCE slightly preferred ingestible medications over topical, the majority indicated a preference for combinations of treatments. This reflects a desire to manage a comprehensive range of OA symptoms effectively. These findings emphasize the need for personalized treatment strategies that align with patient preferences, which could lead to more effective clinical approaches for managing osteoarthritis.

References: . Centers for Disease Control and Prevention. Osteoarthritis (OA) [Internet]. 2020 [cited 2022 Sep 21]. Available from: Grässel S, Muschter D. Recent advances in the treatment of osteoarthritis. F1000Res. 2020;9:F1000 Faculty Rev-325.

3. Silverman S, Schepman P, Rice JB, Beck CG, Pajerowski W, White AG, et al. Risk Factors Associated with Falls and Fractures Following Prescription of Opioids Among Privately Insured Patients with Osteoarthritis. Journal of Health Economics and Outcomes Research [Internet]. 2022 Aug 19 [cited 2022 Sep 21];9(2).