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.

6533b831fe1ef96bd129851b

RESEARCH PRODUCT

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.

Olivier Meyer Michel De Bandt Jean-marie Berthelot Alain Cantagrel Bernard Combe Bruno Fautrel René-marc Flipo Frédéric Lioté Jean-francis Maillefert Alain Saraux Daniel Wendling Francis Guillemin Xavier Le Loët Non Renseigné

subject

MESH: Antirheumatic Agents MESH: Treatment Failure Disease Receptors Tumor Necrosis Factor Etanercept Arthritis Rheumatoid 0302 clinical medicine MESH: Practice Guidelines as Topic 030212 general & internal medicine Treatment Failure skin and connective tissue diseases MESH: Immunoglobulin G MESH: Arthritis Rheumatoid Anti rheumatic drugs 3. Good health Clinical Practice MESH: Methotrexate [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system Rheumatoid arthritis Antirheumatic Agents Practice Guidelines as Topic Drug Therapy Combination Leflunomide musculoskeletal diseases medicine.medical_specialty MESH: Rheumatoid Factor First line MESH: Drug Administration Schedule Drug Administration Schedule Decision Support Techniques 03 medical and health sciences Rheumatology Rheumatoid Factor Dmard therapy medicine Rheumatoid factor Humans Intensive care medicine 030203 arthritis & rheumatology MESH: Humans MESH: Sulfasalazine business.industry MESH: Biological Markers MESH: Decision Support Techniques Early rheumatoid arthritis Isoxazoles medicine.disease MESH: Receptors Tumor Necrosis Factor Radiography Sulfasalazine MESH: Drug Therapy Combination Methotrexate MESH: Isoxazoles Immunoglobulin G Physical therapy business Biomarkers

description

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 pertinent. RESULTS: Recommendations for choosing a second DMARD for early RA after failure of a 6-month course of a first-line DMARD were established according to 4 parameters: type of first-line DMARD, activity, RF status and radiographic joint damage. The results of this study suggest that in patients with early RA who fail a 6-month course of first-line DMARD therapy, the best options may be addition of corticosteroid when disease activity is moderate to high and switching to a biologic agent when further radiographic joint damage occurs, particularly in patients with positive tests for RF. CONCLUSION: Although our scenarios did not include step-up (add instead of substitute) strategies, except for corticosteroids, we feel that the format presented here can optimise the management of patients with early RA seen in clinical practice.

year	journal	country	edition	language
2006-05-02	Joint bone spine

10.1016/j.jbspin.2006.05.008 https://pubmed.ncbi.nlm.nih.gov/17194614