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Singapore Chapter of Rheumatologists Consensus Statement on the Eligibility for Government Subsidy of Biologic Disease Modifying Antirheumatic Agents for Treatment of Rheumatoid Arthritis (RA)
Article en En | WPRIM | ID: wpr-312257
Biblioteca responsable: WPRO
ABSTRACT
<p><b>INTRODUCTION</b>Up to 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional non-biologic disease modifying antirheumatic drugs (nbDMARDs), and may benefit from therapy with biologic DMARDs (bDMARDs). However, the high cost of bDMARDs limits their widespread use. The Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore aims to define clinical eligibility for government-assisted funding of bDMARDs for local RA patients.</p><p><b>MATERIALS AND METHODS</b>Evidence synthesis was performed by reviewing 7 published guidelines on use of biologics for RA. Using the modified RAND/UCLA Appropriateness Method (RAM), rheumatologists rated indications for therapies for different clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate the practice recommendations.</p><p><b>RESULTS</b>Ten recommendations including diagnosis of RA, choice of disease activity measure, initiation and continuation of bDMARD and option of first and second-line therapies were formulated. The panellists agreed that a bDMARD is indicated if a patient has (1) active RA with a Disease Activity Score in 28 joints (DAS28) score of ≥3.2, (2) a minimum of 6 swollen and tender joints, and (3) has failed a minimum of 2 nbDMARD combinations of adequate dose regimen for at least 3 months each. To qualify for continued biologic therapy, a patient must have (1) documentation of DAS28 every 3 months and (2) at least a European League Against Rheumatism (EULAR) moderate response by 6 months after commencement of therapy.</p><p><b>CONCLUSION</b>The recommendations developed by a formal group consensus method may be useful for clinical practice and guiding funding decisions by relevant authorities in making bDMARDs usage accessible and equitable to eligible patients in Singapore.</p>
Asunto(s)
Texto completo: 1 Base de datos: WPRIM Asunto principal: Artritis Reumatoide / Singapur / Guías de Práctica Clínica como Asunto / Antirreumáticos / Usos Terapéuticos / Quimioterapia / Economía / Financiación Gubernamental Tipo de estudio: Guideline / Health_economic_evaluation / Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: Asia Idioma: En Revista: Annals of the Academy of Medicine, Singapore Año: 2014 Tipo del documento: Article
Texto completo: 1 Base de datos: WPRIM Asunto principal: Artritis Reumatoide / Singapur / Guías de Práctica Clínica como Asunto / Antirreumáticos / Usos Terapéuticos / Quimioterapia / Economía / Financiación Gubernamental Tipo de estudio: Guideline / Health_economic_evaluation / Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: Asia Idioma: En Revista: Annals of the Academy of Medicine, Singapore Año: 2014 Tipo del documento: Article