2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease‐modifying anti‐rheumatic drugs in patients with rheumatoid arthritis

Louthrenoo, Worawit; Kasitanon, Nuntana; Katchamart, Wanruchada; Aiewruengsurat, Duangkamol; Chevaisrakul, Parawee; Chiowchanwisawakit, Praveena; Dechanuwong, Pornchai; Hanvivadhanakul, Punchong; Mahakkanukrauh, Ajanee; Manavathongchai, Siriporn; Muangchan, Chayawee; Narongroeknawin, Pongthorn; Phumethum, Veerapong; Siripaitoon, Boonjing; Suesuwan, Anawat; Suwannaroj, Siraphop; Uea-Areewongsa, Parichat; Ukritchon, Sittichai; Asavatanabodee, Paijit; Koolvisoot, Ajchara; Nanagara, Ratanavadee; Totemchokchyakarn, Kitti; Nuntirooj, Kanokrut; Kitumnuaypong, Tasanee

doi:10.1111/1756-185x.13130

Cited by 11 publications

(24 citation statements)

References 154 publications

(222 reference statements)

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“…In this current systematic review, 8 major best practice guidelines, including ACR and EULAR, recommend ≥2 csDMARDs as monotherapy or in combination . Only the Mexican College of Rheumatology guidelines did not address this .…”

Section: Resultsmentioning

confidence: 94%

“…The EULAR, APLAR and Thai Rheumatism Association recommend treatment escalation if there is no improvement by 3 months or inadequate response by 6 months with csDMARDs . The German and Canadian guidelines recommend escalation after 3 months of ≥2 csDMARD strategies at optimal doses .…”

Section: Resultsmentioning

confidence: 99%

“…Four best practice guidelines including the ACR and BSR/BHPR, and the NICE reimbursement guidelines did not specify the optimal dose …”

Section: Resultsmentioning

confidence: 99%

“…Pertaining to the use of TNFi and non‐TNFi (ABT, TCZ) as first‐line, all best practice guidelines except the Canadian, and both NICE and Australia's Medicare reimbursement guidelines, included all as first‐line biologic options in no order of preference …”

Section: Resultsmentioning

confidence: 99%

“…In summary, the CWG reviewed guidelines published from the following: German Society of Rheumatology, Canadian Rheumatology Association, British Society of Rheumatology/ British Health Professionals for Rheumatology (BSR/ BHPR), NICE, Mexican College of Rheumatology, Thai Rheumatism Association, Asia‐Pacific League against Rheumatism (APLAR), Spanish Society of Rheumatology, ACR, EULAR and Australia's Medicare . Recommendations are summarized in Table .…”

Section: Methodsmentioning

confidence: 99%

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Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted‐synthetic therapy for the treatment of rheumatoid arthritis

et al. 2019

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Introduction Approximately 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional‐synthetic disease‐modifying anti‐rheumatic drugs (csDMARDs). However, widespread use of biologic DMARDs (bDMARDs) and targeted‐synthetic (tsDMARDs) is limited by cost. We formulated updated recommendations for eligibility criteria for government‐assisted funding of bDMARDs/tsDMARDs for RA patients in Singapore. Materials and Methods Published guidelines regarding use of bDMARD and tsDMARDs were reviewed. We excluded those without a systematic literature review, formal consensus process or evidence grading. Separately, unpublished national reimbursement guidelines were included. Results Eleven recommendations regarding choice of disease activity measure, initiation, order of selection and continuation of bDMARD/tsDMARDs were formulated. A bDMARD/tsDMARD is indicated if a patient has: (a) at least moderately active RA with a Disease Activity Score in 28 joints/erythrocyte sedimentation rate (DAS28‐ESR) score of ≥3.2; (b) failed ≥2 csDMARD strategies, 1 of which must be a combination; (c) received an adequate dose regimen of ≥3 months for each strategy. For the first‐line bDMARD/tsDMARD, either tumor necrosis factor inhibitors (TNFi), non‐TNFi (abatacept, tocilizumab, rituximab), or tsDMARDs, may be considered. If a first‐line TNFi fails, options include another TNFi, non‐TNFi biologic or tsDMARDs. If a first‐line non‐TNFi biologic or tsDMARD fails, options include TNFi or another non‐TNF biologic or tsDMARD. For continued bDMARD/tsDMARD subsidization, a patient must have a documented DAS28‐ESR every 3 months and at least a moderate European League Against Rheumatism response by 6 months. Conclusion These recommendations are useful for guiding funding decisions, making bDMARD/tsDMARDs usage accessible and equitable in RA patients who fail csDMARDs.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

“…Four best practice guidelines including the ACR and BSR/BHPR, and the NICE reimbursement guidelines did not specify the optimal dose …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted‐synthetic therapy for the treatment of rheumatoid arthritis

et al. 2019

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Safety and efficacy in the nursing care of people with rheumatic diseases on janus kinase inhibitor therapy

Castiblanco¹,

Yébenes

Martín

et al. 2022

Rheumatol Int

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What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines

et al. 2023

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Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. Trial registration The protocol for this review was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/UB3Y7).

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2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease‐modifying anti‐rheumatic drugs in patients with rheumatoid arthritis

Abstract: These recommendations will help Thai rheumatologists prescribe bDMARDs and tsDMARD more appropriately when treating RA patients.

Cited by 11 publications

References 154 publications

Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted‐synthetic therapy for the treatment of rheumatoid arthritis

Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted‐synthetic therapy for the treatment of rheumatoid arthritis

Safety and efficacy in the nursing care of people with rheumatic diseases on janus kinase inhibitor therapy

What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines

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