Tapering biologic therapy for people with rheumatoid arthritis in remission: A review of patient perspectives and associated clinical evidence
| Autor: | Lisa K. Stamp, Gareth J. Treharne, Caitlin Helme, Suz Jack Chan, Carlo A. Marra |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Nursing (miscellaneous) Physical Therapy Sports Therapy and Rehabilitation Tapering Disease Arthritis Rheumatoid Biological Factors 03 medical and health sciences 0302 clinical medicine Rheumatology medicine Decision aids Humans Orthopedics and Sports Medicine 030212 general & internal medicine Intensive care medicine 030203 arthritis & rheumatology business.industry Rehabilitation medicine.disease Clinical research Clinical evidence Antirheumatic Agents Rheumatoid arthritis Dose reduction Chiropractics business Qualitative research |
| Zdroj: | Musculoskeletal Care. 17:161-169 |
| ISSN: | 1557-0681 1478-2189 |
| Popis: | Objectives Biologic therapies have increased the control of disease activity in rheumatoid arthritis (RA). Questions remain about tapering biologics when remission is achieved in RA. The patient perspective has to be incorporated in pragmatic applications of tapering but is rarely accounted for in clinical studies of tapering. The aim of the present review was to summarize the evidence about RA patient perspectives on biologic tapering. Methods We provided a narrative summary of the currently small body of research on patient perspectives retrieved through systematic searches with an emphasis on seeking qualitative research. In addition, we provided an update on relevant clinical research and financial considerations that frame the findings on patient perspectives. Results Financial considerations around commencing/continuing on biologic therapies in RA vary internationally and have implications for patient perspectives. Recent clinical studies indicate that the benefit of tapering biologic therapy when in remission are predicted by drug concentration and aspects of disease activity, severity and duration. Three major concerns have been identified from studies of patient perspectives on biologic tapering: (a) disease relapse; (b) access to treatment in the case of disease flare when tapering; and (c) local motivation for dose reduction (i.e., driven by funding or health benefit). Conclusions More research is needed on tapering biologics, and should include studies of patient perspectives as well as health economic evaluations. Patient decision aids are a potential way of applying clinical and patient-focused evidence to help all parties come to a decision, but require developmental research and pragmatic evaluation. |
| Databáze: | OpenAIRE |
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