医学
生物仿制药
类风湿性关节炎
依那西普
德尔菲
处方集
德尔菲法
银屑病性关节炎
物理疗法
随机对照试验
痹症科
内科学
重症监护医学
家庭医学
人工智能
操作系统
计算机科学
作者
Céleste J T van der Togt,Bart van den Bemt,Daniel Aletaha,Rieke Alten,Katerina Chatzidionysiou,James Galloway,John Isaac,Denis Mulleman,Patrick Verschueren,Arnold G. Vulto,Paco M J Welsing,Lise M Verhoef,Alfons A den Broeder
出处
期刊:RMD Open
[BMJ]
日期:2023-03-01
卷期号:9 (1): e002898-e002898
被引量:5
标识
DOI:10.1136/rmdopen-2022-002898
摘要
To develop evidence-based points to consider for cost-effective use of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the treatment of inflammatory rheumatic diseases, specifically rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis.Following EULAR procedures, an international task force was formed, consisting of 13 experts in rheumatology, epidemiology and pharmacology from seven European countries. Twelve strategies for cost-effective use of b/tsDMARDs were identified through individual and group discussion. For each strategy, PubMed and Embase were systematically searched for relevant English-language systematic reviews and, for six strategies, additionally for randomised controlled trials (RCTs). Thirty systematic reviews and 21 RCTs were included. Based on the evidence, a set of overarching principles and points to consider was formulated by the task force using a Delphi procedure. Level of evidence (1a-5) and grade (A-D) were determined for each point to consider. Individual voting on the level of agreement (LoA; between 0 (completely disagree) and 10 (completely agree)) was performed anonymously.The task force agreed on five overarching principles. For 10 of 12 strategies, the evidence was sufficient to formulate one or more points to consider, leading to 20 in total, regarding response prediction, drug formulary use, biosimilars, loading doses, low-dose initial therapy, concomitant conventional synthetic DMARD use, route of administration, medication adherence, disease activity-guided dose optimisation and non-medical drug switching. Ten points to consider (50%) were supported by level 1 or 2 evidence. The mean LoA (SD) varied between 7.9 (1.2) and 9.8 (0.4).These points to consider can be used in rheumatology practices and complement inflammatory rheumatic disease treatment guidelines to incorporate cost-effectiveness in b/tsDMARD treatment.
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