The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis

Holroyd, Christopher; Seth, Rakhi; Bukhari, Marwan; Malaviya, Anshuman; Holmes, Claire; Curtis, Elizabeth M; Chan, Christopher; Yusuf, Mohammed Abid; Litwic, Anna; Smolen, Susan; Topliffe, Joanne; Bennett, Sarah; Humphreys, Jennifer; Green, Muriel; Ledingham, Jo

doi:10.1093/rheumatology/key298

Cited by 37 publications

(38 citation statements)

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“…The bDMARDS or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission [22]. However, these medications are related with a significant increase in direct costs and with all medications there is a risk of some adverse reactions [16,23]. The present study describes the clinical characteristics, treatment patterns, persistence, and direct healthcare costs associated with bDMARD or tofacitinib treatment in RA patients in Colombia in a reallife context.…”

Section: Discussionmentioning

confidence: 99%

Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

et al. 2020

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Introduction/objectives The objective of this study is to describe the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) or tofacitinib. Method This is a descriptive study from a retrospective cohort of patients diagnosed with RA who were treated with bDMARDs or tofacitinib after failure of conventional DMARDs (cDMARDs) or first bDMARD. Patients who were receiving pharmacological treatment between 01 January 2014 and 30 June 2018 were included. The analysis is through the revision of claim database and electronical medical records. Demographic and clinical data were collected. The costs of healthcare resources were estimated from the billing expense of healthcare service provider. Results We evaluated 588 RA patients on treatment with bDMARDs (n = 505) or tofacitinib (n = 83), most of them were in combination with cDMARDs (85.4%). The 88.1% were females and mean age was 57.3 ± 12.5 years. The median evolution of RA since diagnosis was 9 years (IQR:4–17.2). The mean duration of use during follow-up of the bDMARDs or tofacitinib was similar, with a mean of 9.8 ± 1.9 months. It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost of care per patient was USD 8997 ± 2172, where 97.2% was due to drug costs. The average annual cost of treatment per patient with bDMARDs was USD 8604 and tofacitinib was USD 6377. Conclusions In the face of a first failure of cDMARD, bDMARDs are frequently added. A high frequency of patients do not persist treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare costs. Key Points• Rheumatoid arthritis is a disease with a high burden of comorbidities, complications, and worse health-related quality of life and is associated with elevated healthcare costs.• The biological disease-modifying antirheumatic drugs or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission.• Patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs or tofacitinib represent a significant economic burden to the health system, especially in the costs derived from pharmacological treatment.

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Section: Discussionmentioning

confidence: 99%

Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

et al. 2020

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“…Identification of patients at risk of infectious complications is prudent prior to commencement of immunosuppressive therapy. Screening for latent TB infection (LTBI) and hepatitis B is the most well recognized, while hepatitis C, human immunodeficiency virus (HIV) and strongyloides infection should be considered on an individual patient basis 67,89,90 …”

Section: Approach To Management Of Ctd‐ildmentioning

confidence: 99%

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

et al. 2020

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Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD-ILD), and may vary from limited, non-progressive lung involvement, to fulminant, life-threatening disease. Given the potential for major adverse outcomes in CTD-ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD-ILD. Autoimmunemediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD-ILD. However, the natural history of CTD-ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD-ILD and, where available, evidence-based, diseasespecific approaches to treatment have been provided.

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“…This also brought us in line with the BSR biologic safety guidelines which recommend immunisation for patients on >20mg of corticosteroids for >2 weeks. 8 We also deemed that lower dose steroids (>5mg but <20mg) in conjunction with another immunosuppressive agent constituted a very high risk.…”

Section: Corticosteroidsmentioning

confidence: 99%

Identifying rheumatic disease patients at high risk and requiring shielding during the COVID-19 pandemic

et al. 2020

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Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. The office of the chief medical officer (CMO) for England contacted the rheumatology community to provide expert advice on the identification of extremely vulnerable patients at very high risk during the COVID-19 pandemic who should be 'shielded'. This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England.

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The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis

Cited by 37 publications

References 0 publications

Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

Identifying rheumatic disease patients at high risk and requiring shielding during the COVID-19 pandemic

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