| Popis: |
Background Currently, patients with rheumatoid arthritis (RA) have a wide range of treatments available to achieve a good control of the disease and avoid progression. However, some patients, especially those with poor prognostic factors, need to switch drugs to achieve remission or low disease activity. If we can predict the response to a drug, given specific prognostic profiles, we may be able to choose the best drug for individual patients. Objectives To assess the degree of confidence of rheumatologists regarding the efficacy of biologic therapies and specific targeted synthetic molecules in patients with RA harbouring poor prognostic factors. Methods A Delphi survey was sent to a group of rheumatologists with the aim to capture the perceived efficacy of a group of drugs (antiTNF, T-cell co-stimulants, B-cells depletors, anti IL6, and JAK inhibitors) given different poor prognostic factors are present at the onset of the disease. These factors were: interstitial lung disease, elevated HAQ, positive rheumatoid factor (RF), presence of anti-citrullinated protein antibody (ACPA), elevated acute phase reactants (APR), and bone erosions observed by simple x-ray/ultrasound. The survey was circulated in two rounds, with feed-back from the first round. The degree of confidence in the efficacy of the therapies for each specific prognostic profile was collected on a Likert scale from 1 to 9. The mean (m) and standard deviation (SD) were calculated; agreement was considered if SD ≤1 and 80% of the scores were in one of the three levels (correspondingly it would be agreement on “ineffectiveness”, ldquo;neutrality” and “effectiveness”). Conclusion There is agreement among rheumatologists regarding the behaviour of particular drugs on particular prognostic profiles, except in the case of interstitial pulmonary involvement, HAQ, ACPA+ and acute phase reactants, where there may be differences in the perception of efficacy. This perception of efficacy should be contrasted with scientific evidence Acknowledgement This study was funded by Bristol-Myers Squibb. Disclosure of Interests Loreto Carmona Grant/research support from: Abbvie, Actelion, Astellas, BMS, Eisay, Gebro Pharma, Grunenthal, Leo Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis and UCB Pharma, Paid instructor for: Novartis, J. Narvaez Consultant for: Bristol-Myers Squibb, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb, Alejandro Escudero Contreras: None declared, Santiago Munoz Fernandez: None declared, Jose M. Rodriguez-Heredia: None declared, Susana Romero-Yuste: None declared, Paloma Vela Casasempere: None declared, Jose Luis Baquero Grant/research support from: MS, Abbvie, Roche, Becton Dickinson and General Electric, Employee of: Wyeth (10 years ago), Sara Lujan Valdes Employee of: Full time employee at Bristol-Myers Squibb, Juan J Sancho Jimenez Employee of: Full time employee at Bristol-Myers Squibb |
