Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region: an exemplar of the GRADE Adolopment

Darzi, Andrea; Harfouche, Manale; Arayssi, Thurayya; Al‐Emadi, Samar; Alnaqbi, Khalid A.; Badsha, Humeira; Balushi, Farida Al; Elzorkany, Bassel; Halabi, Hussein; Hamoudeh, Mohammed; Hazer, Wissam; Masri, Basel; Omair, Mohammed A.; Uthman, Imad; Ziadé, Nelly; Singh, Jasvinder A.; Christiansen, Robin; Tugwell, Peter; Schünemann, Holger J.; Akl, Elie A.

doi:10.1186/s12955-017-0754-1

Cited by 29 publications

(32 citation statements)

References 17 publications

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“…Methotrexate is considered the standard of care in guidelines for RA management on both sides of the Atlantic and is a commonly adopted strategy among the majority of rheumatologists in Saudi Arabia and the Eastern Mediterranean region . Rheumatologists tend to push patients to continue MTX because MTX monotherapy or MTX‐based DMARD combination therapy is the first step for patients with moderate to severe disease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of methotrexate intolerance among patients with rheumatoid arthritis using the Arabic version of the methotrexate intolerance severity score

et al. 2019

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Aim: Methotrexate (MTX) is the anchor drug for the treatment of rheumatoid arthritis (RA). MTX is associated with adverse events that limit its use. The MTX intolerance severity score (MISS) was developed to identify symptoms related to MTX use in juvenile idiopathic arthritis and RA patients. The aim of this study is to translate and validate the MISS in the Arabic language.Methods: Forward and backward translation of the MISS were performed by two fluent Arabic translators and reviewed by three rheumatologists. Consecutive patients with RA who used MTX for ≥3 months were recruited from two tertiary care centers in Riyadh, Saudi Arabia. A test was considered positive if the patient scored ≥6 points. The internal consistency and stability of the items were evaluated using Cronbach's alpha and the test-retest method.Results: A total of 185 patients were recruited. Of those patients, 158 (85.4%) were female. The mean (±SD) age and disease duration were 49.7 (±12.67) and 8.67 (±7.1) years, respectively. The mean Disease Activity Score of 28 joints was 3.2 (±1.3).Fifty-five (30%) patients were illiterate. Seventy-three (39.5%) patients had a positive MISS. Of those patients, 55 (75.3%) and 18 (24.7%) were using the oral and subcutaneous forms of MTX, respectively. The Arabic MISS had good internal consistency (Cronbach's alpha = 0.792) and a factorable study size for test-retest and factor analysis (Kaiser-Meyer-Olkin = 0.745). Conclusion:The Arabic MISS showed validity and good reliability in detecting MTX intolerance in RA patients. MTX intolerance is prevalent among RA patients. Larger studies are needed to confirm these findings. K E Y W O R D Scross-cultural validation studies, methotrexate, methotrexate intolerance severity score, rheumatoid arthritis | 1573 ALBAQAMI et AL.

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Section: Discussionmentioning

confidence: 99%

Prevalence of methotrexate intolerance among patients with rheumatoid arthritis using the Arabic version of the methotrexate intolerance severity score

et al. 2019

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“…The process proved to be feasible, with each wave of adaptation lasting 6 months, and requiring a total budget of 40,000 USD. The feasibility was facilitated by using existing systematic reviews and collaborating with ACR, the source guideline organization [10]. A key factor in ensuring the success of the project was the high level of expertise on both the content and methodological levels.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously reported the methodology used for this project [10] in relation to the following: (1) groups and roles; (2) selecting guideline topics; (3) identifying and training guideline panelists; (4) prioritizing questions and outcomes; (5) identifying, updating, or conducting systematic reviews; (6) preparing GRADE evidence tables and EtD frameworks; (7) formulating and grading strength of recommendations; (8) using the GRADEpro-GDT software (www. gradepro.org).…”

Section: Methodsmentioning

confidence: 99%

Recommendations for the management of rheumatoid arthritis in the Eastern Mediterranean region: an adolopment of the 2015 American College of Rheumatology guidelines

et al. 2018

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Clinical practice guidelines can assist rheumatologists in the proper prescription of newer treatment for rheumatoid arthritis (RA). The objective of this paper is to report on the recommendations for the management of patients with RA in the Eastern Mediterranean region. We adapted the 2015 American College of Rheumatology guidelines in two separate waves. We used the adolopment methodology, and followed the 18 steps of the "Guidelines 2.0" comprehensive checklist for guideline development. For each question, we updated the original guidelines' evidence synthesis, and we developed an Evidence Profile (EP) and an Evidence to Decision (EtD) table. In the first wave, we adoloped eight out of the 15 original questions on early RA. The strength changed for five of these recommendations from strong to conditional, due to one or more of the following factors: cost, impact on health equities, the balance of benefits, and harms and acceptability. In the second wave, we adoloped eight out of the original 44 questions on established RA. The strength changed for two of these recommendations from strong to conditional, in both cases due to cost, impact on health equities, balance of benefits and harms, and acceptability. The panel also developed a good practice recommendation. We successfully adoloped 16 recommendations for the management of early and established RA in the Eastern Mediterranean region. The process proved feasible and sensitive to contextual factors.

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“…While we have used the third approach in previous ADOLOPMENT projects [19][20][21][22][23][24], we opted to go for the second approach in this project. The decision was driven by the preference of the adoloping panel, and by the scarcity of local evidence from Tunisia.…”

Section: Discussionmentioning

confidence: 99%

Contextual differences considered in the Tunisian ADOLOPMENT of the European Guidelines on Breast Cancer Screening

Kahale

Ouertatani

Brahem

et al. 2020

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Background Breast cancer is a common disease in Tunisia and is associated with high mortality rates. The “Instance Nationale de l’Evaluation et de l’Accréditation en Santé” (INEAS) and the Tunisian Society of Oncology decided to develop practice guidelines on the subject. While the development of de novo guidelines on breast cancer screening is a demanding process, guideline adaptation appears more appropriate and context sensitive. The objective of this paper is to describe the adaptation process of the European Guidelines on Breast Cancer Screening and Diagnosis to the Tunisian setting in terms of the methodological process, contextual differences between the source and adoloped guideline, and changes in the recommendations.Methods We used the GRADE-ADOLOPMENT methodology to prioritize the topic, select the source guideline, and prioritize the questions and the outcomes. Once the source guideline was selected- the European Breast Cancer Guidelines- the European Commission´s Joint Research Centre shared with the project team in Tunisia all relevant documents and files. In parallel, the project team searched for local studies on the disease prevalence, associated outcomes’ baseline risks, patients’ values and preferences, cost, cost-effectiveness, acceptability and feasibility. Then, the adoloping panel reviewed the GRADE evidence tables and the Evidence to Decision tables and discussed whether their own judgments were consistent with those from the source guideline or not. They based their judgments on the evidence on health effects, the local evidence and their own experiences.Results The most relevant contextual differences between the source and adoloped guidelines were related to the perspective, scope, prioritized questions, rating of outcome importance, baseline risks, and indirectness of the evidence. The ADOLOPMENT process resulted in keeping 5 out of 6 recommendations unmodified. One recommendation addressing “screening versus no screening with ultrasound in women with high breast density on mammography screening” was modified from ‘conditional against’ to ‘conditional for either’ due to more favorable ratings by the adoloping panel in terms of equity and feasibility.Conclusion This process illustrates both the feasibility of GRADE-ADOLOPMENT approach and the importance of consideration of local evidence. It also highlights the value of collaboration with the organization that developed the source guideline.

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Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region: an exemplar of the GRADE Adolopment

Cited by 29 publications

References 17 publications

Prevalence of methotrexate intolerance among patients with rheumatoid arthritis using the Arabic version of the methotrexate intolerance severity score

Prevalence of methotrexate intolerance among patients with rheumatoid arthritis using the Arabic version of the methotrexate intolerance severity score

Recommendations for the management of rheumatoid arthritis in the Eastern Mediterranean region: an adolopment of the 2015 American College of Rheumatology guidelines

Contextual differences considered in the Tunisian ADOLOPMENT of the European Guidelines on Breast Cancer Screening

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