Physician practices for withdrawal of medications in inactive systemic juvenile arthritis, Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey

Autor: Susan Shenoi, Kabita Nanda, Grant S. Schulert, John F. Bohnsack, Ashley M. Cooper, Bridget Edghill, Miriah C. Gillispie-Taylor, Baruch Goldberg, Olha Halyabar, Thomas G. Mason, Tova Ronis, Rayfel Schneider, Richard K. Vehe, Karen Onel, for the Childhood Arthritis and Rheumatology Research Alliance Systemic Juvenile Idiopathic Arthritis Workgroup
Jazyk: angličtina
Rok vydání: 2019
Předmět:
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
Childhood arthritis
Attitude of Health Personnel
Clinical Decision-Making
CARRA
Arthritis
Antibodies
Monoclonal
Humanized
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Tocilizumab
Deprescriptions
Rheumatology
Adrenal Cortex Hormones
Internal medicine
Surveys and Questionnaires
medicine
Immunology and Allergy
Humans
030212 general & internal medicine
Adverse effect
030203 arthritis & rheumatology
Response rate (survey)
Anakinra
business.industry
Inactive disease
lcsh:RJ1-570
lcsh:Pediatrics
Systemic Juvenile Idiopathic Arthritis
16. Peace & justice
medicine.disease
Arthritis
Juvenile
3. Good health
Canakinumab
Interleukin 1 Receptor Antagonist Protein
Methotrexate
chemistry
Withdrawal of medications
Antirheumatic Agents
Pediatrics
Perinatology and Child Health
lcsh:RC925-935
Rheumatologists
business
medicine.drug
Research Article
Zdroj: Pediatric Rheumatology Online Journal
Pediatric Rheumatology Online Journal, Vol 17, Iss 1, Pp 1-7 (2019)
ISSN: 1546-0096
Popis: Background We describe a Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey of North American pediatric rheumatologists that assesses physician attitudes on withdrawal of medications in systemic juvenile idiopathic arthritis (SJIA). Methods A REDCap anonymous electronic survey was distributed to 100 random CARRA JIA workgroup physician-voting members. The survey had three broad sections including: A) demographic information; B) physicians’ opinions on clinical inactive disease (CID) in SJIA and C) existing practices for withdrawing medications in SJIA. Results The survey had an 86% response rate. 88 and 93% of participants agreed with the current criteria for CID and clinical remission on medications (CRM) respectively. 78% thought it necessary to meet CRM before tapering medications except steroids. 76% use CARRA SJIA consensus treatment plans always or the majority of the time. All participants weaned steroids first in SJIA patients on combination therapy, 47% waited > 6 months before tapering additional medications. 35% each tapered methotrexate over > 6 months and 2–6 months; however, 39% preferred tapering anakinra, canakinumab and tocilizumab more quickly over 2–6 months and favored spacing the dosing interval for canakinumab and tocilizumab. When patients are on combination therapy with methotrexate and biologics, 58% preferred tapering methotrexate first while others considered patient/family preference and adverse effects to guide their choice. Conclusion Most CARRA members surveyed use published consensus treatment plans for SJIA and agree with validated definitions of CID and CRM. There was agreement with tapering steroids first in SJIA. There was considerable variability with tapering decisions of all other medications. Electronic supplementary material The online version of this article (10.1186/s12969-019-0342-5) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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