Better After CHoosing in rheumatoid arthritis (the BACH trial): patients who have the opportunity to choose their treatment are more satisfied
Authors' conclusion
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.
Study context
- Population
- Patients with biologic (DMARD)-naïve active rheumatoid arthritis (RA) after failure of conventional disease-modifying antirheumatic drugs (DMARDs)patients randomised 1:1
- Participants
- 102 patients
- Comparison
- Personally choosing between subcutaneous tumour necrosis factor inhibitor (TNFi) or oral Janus kinase inhibitor (JAKi) filgotinib vs being randomised 1:1 to the same treatment options
Primary result
As reported in the abstract
Treatment chosen in the patient-choice group
Chose JAKi treatment
55%
n=28
Chose subcutaneous TNFi
45%
n=23
Further findings
| Outcome | PATIENT-CHOICE | RANDOMISED | P value |
|---|---|---|---|
| Treatment satisfaction · 24 weeksSignificantly higher in the patient-choice group | 46 | 33 | P = 0.032 |
| Patients who switched to a different mode of action · week 12Fewer in the patient-choice group | 6 events | 15 events | P = 0.026 |
| Mean Disease Activity Score in 28 joints using erythrocyte sedimentation rate · week 24 | 2.24 | 2.71 | P = 0.083 |
| Glucocorticoid use · week 24More glucocorticoids used in the randomised group | 4 events | 12 events | P = 0.031 |
- Mean Disease Activity Score in 28 joints using erythrocyte sedimentation rate: numerically, but not significantly, lower in the patient-choice group
Safety
| Outcome | PATIENT-CHOICE | RANDOMISED | P value |
|---|---|---|---|
| Number of adverse events per patientSignificantly higher in the randomised group | 1.61 | 2.02 | P = 0.046 |
Original publication
Better After CHoosing in rheumatoid arthritis (the BACH trial): patients who have the opportunity to choose their treatment are more satisfied. RMD Open. Published 27 October 2026. doi:10.
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