Background: Chronic asthma is one of the most common childhood conditions. However, discrepancies can be identified amongst treatment recommendations made by clinical practice guidelines for the management of this condition. As such, the proposed systematic review will aim to summarise and compare paediatric chronic asthma guideline recommendations, to promote the development of cohesive guidelines for the appropriate management of this patient cohort. Methods: Our proposed systematic review will identify guidelines for chronic paediatric asthma management. The MEDLINE, Embase and Scopus databases were searched using synonyms of the following keywords: “asthma” AND “guidelines” AND “treatment” AND “pediatrics”.The quality of included studies will be assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Narrative synthesis will be used to describe the quality and recommendations of the guidelines. Discussion: The results of this systematic review will enhance clinical decision-making in the management of paediatric chronic asthma, and will additionally identify heterogeneity in guidelines internationally. These outcomes may minimise this heterogeneity and promote the development of an established common treatment matrix in future guidelines. Additionally, this systematic review will aid researchers in identifying gaps in knowledge and further avenues for clinical study. The results of this systematic review will be published in a peer-reviewed journal and presented at conferences.
Background/Aims Much discussion surrounds the optimal therapeutic treatment plan for biologic and targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) when treating psoriatic arthritis (PsA). The current study aims to identify predictors of treatment response among PsA patients initiating bDMARD/tsDMARD treatment, focusing on disease activity, functional status (Health Assessment Questionnaire, HAQ), and comorbidities. Methods The systematic review of clinical trials and observational studies used Medline, Embase and Cochrane databases. Eligible studies included full text papers with quantitative estimates of effect (or data to allow these to be computed). Papers also required a validated assessment of treatment response i.e., Minimal Disease Activity (MDA), or some other marker of treatment response such as treatment continuation. Case reports and conference abstracts were excluded. Results From 2824 articles identified, 27 were included. Across these, >15 different outcomes were used, and measured at > 10 different timepoints. There was consistent evidence to suggest that higher baseline disease activity was associated with a reduction in the likelihood of treatment response, see Table 1. Some studies reported up to 20% reduction in odds of LDA at 6 months associated with each 1 unit increase in DAPSA. Others demonstrated that patients with a high DAS28 (>3.2) experienced over a 90% reduction in the odds of MDA at 12 weeks. Eleven studies (from 15) demonstrated a significant association between baseline function and odds of treatment response. Each 1 unit increase in HAQ-DI decreased the odds of a good EULAR response at 3 months by up to 66%. The presence of comorbidities was also consistently associated with a decrease in treatment response. Studies showed that the presence of comorbidities at baseline lessened the odds of MDA at 6 months by up to 80%. Others reported that comorbidities were associated with a reduction in the odds of 5 year treatment persistence by up to 40%. Conclusion This review shows clear evidence of reduced bDMARD/tsDMARD response in PsA among patients with disease activity, poor function, and comorbidities. Clinicians should be aware of the reduced chances of treatment success and should consider early review of therapy, to consider whether treatment escalation or switching is required. Disclosure C. Addae-Kyereme: None. S. Lembke: None. G.J. Macfarlane: None. G.T. Jones: None.
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