Choice of second-line disease-modifying antirheumatic drugs after failure of methotrexate therapy for rheumatoid arthritis: A decision tree for clinical practice based on rheumatologists' preferences
Objective To survey rheumatologists' preferences for the choice of a second-line disease-modifying antirheumatic drug (DMARD) after inadequate response with methotrexate (MTX) therapy in rheumatoid arthritis (RA). Methods Thirty-six rheumatologists stated their preferences for RA treatment after inadequate response with MTX therapy (optimal dose at least 6 months). From the initial scenario, we derived 54 vignettes varying by rheumatoid factor or anti–cyclic citrullinated peptide antibody presence, swollen joint count, Disease Activity Score in 28 joints, and structural damage. Respondents stated their preference among 5 therapeutic options: MTX continuation, switch to another conventional …
Clinical practice format for choosing a second-line disease modifying anti-rheumatic drug in early rheumatoid arthritis after failure of 6 months' first-line DMARD therapy.
International audience; BACKGROUND: The objective was to develop a clinical practice format for choosing a second-line disease-modifying anti-rheumatic drug (DMARD) after a 6-month course of a first-line DMARD in patients with early RA. METHODS: A panel of 34 experts selected treatment option from various scenarios using the Thurstone pairwise method. The experts had to choose between two proposed DMARDs without proposing other options. The scenarios were obtained using the three items: DAS28, rheumatoid factor status and radiographic structural damage. A sample of 240 among 480 scenarios for each expert was taken at random. Responses given by at least 20% of the experts were considered per…
Prédiction de la réponse aux traitements de fond antirhumatismaux (DMARD) dans la polyarthrite rhumatoïde
Resume Objectif Examiner les facteurs potentiels predictifs de la reponse aux traitements de fond (DMARD) classiques dans la polyarthrite rhumatoide (PR). Methodes (1) design de l’etude : etude prospective sur six mois de suivi. Participants : patients avec une PR active ; (2) intervention et suivi : introduction d’un DMARD. Reponse au traitement evaluee a six mois (criteres ACR20) ; (3) analyse : facteurs potentiels predictifs de la reponse : criteres demographiques, activite de la maladie, pourcentages de sous-populations de cellules mononucleees du sang peripherique (CMSP) exprimant la glycoproteine P, taux d’interleukine 1 beta (IL-1β) serique, IL-6, IL-8, IL-10, IL-12 et de facteur de…
Prediction of response to disease modifying antirheumatic drugs in rheumatoid arthritis.
Abstract Aim To investigate potential predictors of response to conventional DMARDs in RA. Methods Study design – 6-month follow-up prospective study. Participants RA patients with active disease. Intervention and follow-up Introduction of one DMARD. Response to treatment evaluated at 6 months (ACR20 criteria). Analysis Potential predictors of response, patients’ demographics, disease activity, percentages of PBMC subsets expressing P-gp, serum IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α levels, were evaluated using univariate and multivariate logistic regression analysis. ROC curve analyses were performed in order to obtain thresholds allowing the prediction of response. Results Forty-two patie…