Australian recommendations on tapering of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in inflammatory arthritis.

Autor: Whittle SL; Rheumatology Unit, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Glennon V; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Johnston RV; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Avery JC; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.; School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia., Bell JS; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia., Brennan SE; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Fong C; Eastern Clinical Research Unit, Eastern Health Box Hill Hospital and Monash University, Melbourne, Victoria, Australia., Hissaria P; School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia., Horgan B; Consumer and Community Involvement Program, Western Australian Health Translation Network, Perth, Western Australia, Australia., O'Neill S; Sydney Musculoskeletal Health Flagship, University of Sydney Northern Clinical School, and Royal North Shore Hospital, Sydney, New South Wales, Australia., Pisaniello HL; School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia., Trevena L; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia., Whittaker GA; Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia., Wluka A; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Buchbinder R; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Internal medicine journal [Intern Med J] 2022 Oct; Vol. 52 (10), pp. 1799-1805.
DOI: 10.1111/imj.15816
Abstrakt: Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) have been an important advance in the management of inflammatory arthritis, but are expensive medications, carry a risk of infection and other adverse effects, and are often perceived as a burden by patients. We used GRADE methodology to develop recommendations for dose reduction and discontinuation of b/tsDMARD in people with rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA) who have achieved a low disease activity state or remission. The recommendations form part of the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis, an NHMRC-endorsed 'living' guideline, in which recommendations are updated in near real-time as new evidence emerges. Conditional recommendations were made in favour of dose reduction in RA and AxSpA but not in PsA. Abrupt discontinuation of b/tsDMARD is not recommended in any of the three diseases.
(© 2022 Royal Australasian College of Physicians.)
Databáze: MEDLINE
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