A survey of United States rheumatologists concerning effectiveness of disease‐modifying antirheumatic drugs and prednisone in the treatment of rheumatoid arthritis

Wolf, Frederick; Albert, Daniel A.; Pincus, Theodore

doi:10.1002/art.1790110508

Cited by 11 publications

(3 citation statements)

References 18 publications

(12 reference statements)

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“…First, we chose not to send reminders and second mailings, in order to respect physicians' right to refuse participation, and as a result achieved a participation rate of 42.5%. This response rate, however, is consistent with (12,15) , or better than (16) , previous surveys of rheumatologists in the US. In addition, because the questionnaires were returned anonymously, we do not have any information on the non-responders.…”

Section: Discussionsupporting

confidence: 89%

Are rheumatologists' treatment decisions influenced by patients' age?

2006

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Section: Discussionsupporting

confidence: 89%

Are rheumatologists' treatment decisions influenced by patients' age?

2006

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“…Chronic inflammation of the synovial membrane induces bone and cartilage destruction with erosions and joint space narrowing, which are partly related and worsen gradually over time (), predominantly during the first few years of the disease. In rheumatoid arthritis (RA), the rate of progression is highest during the first 2 years and most of the damage occurs within the first 5 years (). The goal of pharmacotherapy is to decrease both disease activity and joint progression.…”

Section: Introductionmentioning

confidence: 99%

First‐Year Radiographic Progression as a Predictor of Further Progression in Early Arthritis: Results of a Large National French Cohort

Tobón

Saraux

Lukas³

et al. 2013

Arthritis Care & Research

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Objective. A major goal in the treatment of recent arthritis is the prevention of joint destruction. The value of radiographic progression in the first year for predicting further radiographic progression has not been evaluated comparatively with conventional predictive factors. Methods. Patients with arthritis of <6 months' duration were included in the prospective French ESPOIR cohort. Radiographs were obtained and modified Sharp scores were determined by a blinded reader. The rate of progression was determined over the first year, then over the second and third years. Rapid progression was defined as a >5-point annual increase in the total Sharp score. Results. In total, 500 patients had complete data available after 3 years and were included. The total Sharp score indicated rapid progression in 123 patients (25%) in year 1 and 92 patients (18%) in years 2/3. By logistic regression, the variables independently associated with rapid progression in years 2/3 were year 1 rapid progression of the erosion and total Sharp scores, baseline erosion Sharp score, the serologic American College of Rheumatology/European League Against Rheumatism criterion, and interleukin-6 level. When these variables were combined, year 1 rapid progression made the largest contribution to predicting years 2/3 rapid progression. Conclusion. First-year radiologic progression is the best independent predictor of further rapid progression in early arthritis.

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“…Long-term observational studies are also used to evaluate therapies but these require investment in terms of time and money. A third approach, in addition to RCTs and long-term observation studies, is to survey rheumatologists regarding their opinions on newer therapies (Wolfe, Albert, & Pincus, 1998).…”

Section: Phase IImentioning

confidence: 99%

Assessing the cost-effectiveness of tumor necrosis factor inhibitors and prescribing practices of rheumatologists in patients with rheumatoid arthritis

Kamal¹

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Three new tumor necrosis factor (TNF) inhibitors, adalimumab, etanercept, and infliximab, have been approved for use in patients with active RA. The goals of the study were two fold: 1) to perform a cost-effectiveness analysis of the three TNF inhibitors in patients with RA that inadequately respond to MTX alone and 2) to assess the current prescribing patterns, laboratory monitoring practices, and perceived barriers of rheumatologists in prescribing these agents in patients with RA. Phase I involved the development of a Markov simulation model to estimate the health effects and costs associated with five treatment strategies in patients with RA that inadequately respond to MTX alone: (1) adalimumab plus MTX, (2) etanercept plus MTX, (3) infliximab plus MTX, (4) leflunomide plus MTX, and (5) standard therapy of MTX. A hypothetical cohort of 10,000 55-year old women was evaluated using Monte Carlo simulation. The study was conducted from a societal perspective. The main outcome measures were net gains in quality-adjusted life expectancy and incremental costeffectiveness ratios, (ICERs) in dollars per quality adjusted life year (QALY) gained. Costs and effects were discounted at 3%. Etanercept plus MTX was the most costeffective treatment with an ICER of $49,724/QALY. Leflunomide plus MTX was the second most cost-effective option with an ICER of $52,833/QALY. One-way and probabilistic sensitivity analyses indicated that the conclusions were relatively stable to variations in model assumptions. In phase II, a survey was mailed to a randomly selected national sample of rheumatologists, of which 22.3% responded. The survey findings indicated that TNF inhibitor use was not restricted to moderate and severe patients with RA. Also, TNF inhibitor plus one disease modifying anti-rheumatic drug was the treatment of choice in patients with severe RA that inadequately respond to MTX alone. Costs to the patient and insurance coverage were perceived as major barriers in prescribing TNF inhibitors. One-fourth of the rheumatologists reported not using any monitoring guidelines for the TNF inhibitors indicating a need to revise monitoring guidelines or perhaps implement new guidelines for TNF inhibitors. ACKNOWLEDGEMENT First and foremost, I would like to thank my advisor and Committee Chairperson Dr. Suresh Madhavan for his guidance, encouragement, and constant support throughout my dissertation and graduate studies. His patience and never wavering good nature always eased the frustration that was encountered over the years.

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A survey of United States rheumatologists concerning effectiveness of disease‐modifying antirheumatic drugs and prednisone in the treatment of rheumatoid arthritis

Abstract: Objective. To collect the ratings of American rheumatologists regarding relative short-term and long-term effectiveness of disease-modifying antirheumatic drug(DMARD] therapyin the treatment of

Cited by 11 publications

References 18 publications

Are rheumatologists' treatment decisions influenced by patients' age?

Are rheumatologists' treatment decisions influenced by patients' age?

First‐Year Radiographic Progression as a Predictor of Further Progression in Early Arthritis: Results of a Large National French Cohort

Assessing the cost-effectiveness of tumor necrosis factor inhibitors and prescribing practices of rheumatologists in patients with rheumatoid arthritis

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