Rheumatology Advance Access originally published online on September 15, 2008
Rheumatology 2008 47(11):1698-1703; doi:10.1093/rheumatology/ken348
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Eligibility of rheumatoid arthritis patients for anti-TNF-
therapy according to the 2005 recommendations of the French and British Societies for Rheumatology
1Department of Rheumatology, University Teaching Hospital Pitié-Salpêtrière, Paris 2Department of Rheumatology, University Teaching Hospital Roger Salengro, Lille and 3Department of Rheumatology, University Teaching Hospital La Cavale Blanche, Brest, France.
Correspondence to: B. Fautrel, Service de Rhumatologie, Groupe Hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris Cedex 13, France. E-mail: bruno.fautrel{at}psl.ap-hop-paris.fr
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Abstract |
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Objectives. Several anti-TNF-
prescription guidelines in RA have been published, among which those issued by the British (BSR) and French (SFR) Societies for Rheumatology in 2005 are the most comprehensive. Objectives of the PRISME II survey were to assess and compare eligibility for anti-TNF- therapy of RA patients consulting their usual rheumatologist according to (i) the SFR and BSR guidelines and (ii) the rheumatologist's opinion.
Methods. PRISME II was a postal, cross-sectional, observational survey proposed to all office-based rheumatologists practising in France in 2005. Rheumatologists were to include three consecutive consulting anti-TNF--naïve RA patients. Disease activity was assessed using the disease activity score 28 (DAS28). Structural damage progression was estimated based on the reading by the usual rheumatologist. The factors determining eligibility in the rheumatologists’ opinion were identified by a logistic regression analysis.
Results. Four hundred and thirty-four rheumatologists included 1132 patients. Ongoing RA structural progression was reported for 41% of the patients. According to the SFR and BSR criteria, 64 patients (7.0%) and 10 patients (0.9%), respectively, were eligible for anti-TNF- therapy, while 10% were deemed eligible according to the rheumatologists’ opinion. Determinants of eligibility according to the rheumatologists were: high disease activity (DAS28 >5.1), ongoing structural progression and elevated daily corticosteroid intake. These three determinants feature in the SFR guideline.
Conclusions. The proportion of RA patients eligible for anti-TNF- therapy varies greatly according to the BSR or SFR guidelines. In France, there is a remarkable convergence between rheumatologists’ opinion and SFR guideline regarding the main factors to consider for initiation of an anti-TNF- therapy.
KEY WORDS: Rheumatoid arthritis, DMARD, Anti-TNF- therapy, Biologics, Eligibility criteria, Prescription habits, Daily practice, Cross-sectional observational survey, Guidelines
Submitted 30 January 2008;
revised version accepted 24 July 2008.
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