Work

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

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

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.

Source: RMD Open

DOI: 10.1136/rmdopen-2026-007406