OP0312 International league of associations for rheumatology (ILAR) treatment recommendations for psoriatic arthritis in resource-poor countries

Abstract

BackgroundThe European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) updated their respective recommendations for the management of PsA in 2015. However, these guidelines are primarily based on studies conducted in resource replete countries; hence they may not be applicable to countries in Central and South America, and Africa. Therefore, new ILAR recommendations have been developed for these regions adapted from existing recommendations.ObjectivesTo establish ILAR recommendations for the management of PsA in resource poor settings, particularly Central/South America and Africa, using an expert local panel, adaptation of existing EULAR and GRAPPA treatment recommendations and a new systematic literature review (SLR) for specific issues in resource-poor countries.MethodsThe ADAPTE Collaboration process1 for guideline adaptation was followed to assess and adapt the EULAR and GRAPPA treatment recommendations for PsA covering the Americas and Africa. The process was conducted according to its three phases: set-up phase (identifying and seeing agreement from a panel of participants from the relevant countries), adaptation phase (defining health questions using the PIPOH tool, assessing the two source recommendations, conducting an SLR to answer health questions not addressed in the two source recommendations, assessing quality of source recommendations, assessing applicability of principles contained in the source recommendations, and drafting adapted recommendations), and finalisation phase (external review, aftercare planning and final production).ResultsFive principles for the management of PsA were developed addressing 1. Goals of therapy, 2. Assessment of domains, 3. Assessment of relevant comorbidities, 4. Safety of pharmacotherapy and shared decision making, and 5. Frequency of follow up. Six recommendations for the management of PsA were also developed addressing 1. Goals of therapy, 2. Screening and management of tuberculosis, HIV, HBV, HCV, Chagas’ disease, leishmaniasis, leprosy, and other concomitant comorbidities, 3. Frequency of monitoring in resource poor countries, 4. Safety and efficacy of pharmacotherapy in all domains, 5. Efficacy and safety of combination therapy, and 6. Safety and efficacy of biosimilars and intended copies.ConclusionsILAR recommendations for the management of PsA in resource-poor countries are now available, developed by adapting principally the GRAPPA recommendations, but also the EULAR recommendations, supplemented by expert opinion from these regions.Reference[1] The ADAPTE Collaboration. The ADAPTE Process: Resource Toolkit for Guideline Adaptation, Version 2.0 2009. [Available from] http://wwwg-i-n.netDisclosure of InterestNone declared

Disease burden and treatment challenges of psoriatic arthritis in Africa and the Middle East

“…As current treatment guidelines may not be directly applicable in resource-poor countries, such as those in Central/ South America and Africa, ILAR has recently adapted the GRAPPA and EULAR guidelines for this purpose. These adapted recommendations are mainly based on GRAPPA, with some EULAR recommendations, and have incorporated input from local regional experts [39]. While these adapted recommendations may not be useful throughout the whole of Africa and the Middle East, they are a step toward developing regional guidelines.…”

GRAPPA 2018 Project Report

“…In particular, this project focused on Central America, South America, and Africa. The results of this review and the adapted recommendations were presented at EULAR in Amsterdam in June 2018 4 and will be submitted for publication by the end of 2018.…”