1
|
van der Schoot LS, Janssen JJ, Bastiaens MT, de Boer-Brand A, Christiaansen-Smit C, Enomoto DNH, Hovingh R, Tupker RA, Seyger MMB, Verhoef LM, van den Reek JMPA, de Jong EMGJ. Steps towards implementation of protocolized dose reduction of adalimumab, etanercept and ustekinumab for psoriasis in daily practice. J DERMATOL TREAT 2023; 34:2186728. [PMID: 36867069 PMCID: PMC10013325 DOI: 10.1080/09546634.2023.2186728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Dose reduction (DR) of adalimumab, etanercept and ustekinumab has proven to be (cost-)effective in psoriasis patients with low disease activity. Further implementation is needed to establish application of DR for eligible patients. OBJECTIVES To evaluate the implementation of protocolized biologic DR in daily practice. METHODS A pilot implementation study was performed in 3 hospitals during 6 months. By combining education and protocol development, involved healthcare providers (HCPs) were directed toward the adoption of protocolized DR. DR of adalimumab, etanercept, and ustekinumab was achieved by stepwise injection interval prolongation. Implementation outcomes (fidelity, feasibility) were assessed. Factors for optimizing implementation were explored in interviews with HCPs. Uptake was measured in patients by chart review. RESULTS The implementation strategy was executed as planned. Implementation fidelity was less than 100% as not all provided tools were used across study sites. HCPs indicated the feasibility of implementing protocolized DR, although time investment was needed. Identified additional factors for successful implementation included support for patients, uptake of DR into guidelines, and supportive electronic health record systems. During the 6 months intervention period, 52 patients were eligible for DR of whom 26 (50%) started DR. The proposed DR protocol was followed in 22/26 patients (85%) on DR. CONCLUSION Additional staff for support, extra time during consultations, education on DR for HCPs and patients, and effective tools such as a feasible protocol can lead to more patients on biologic DR.
Collapse
Affiliation(s)
- L S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J Janssen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M T Bastiaens
- Department of Dermatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - A de Boer-Brand
- Department of Dermatology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - C Christiaansen-Smit
- Department of Dermatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - D N H Enomoto
- Department of Dermatology, Dermatologisch Centrum Isala, Zwolle, The Netherlands
| | - R Hovingh
- Department of Dermatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - R A Tupker
- Department of Dermatology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - M M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Santos-Moreno P, Sánchez-Vanegas G, Monterrosa-Blanco A, Rodríguez-Vargas GS, Rivero M, Rodriguez P, Calixto OJ, Rojas-Villarraga A, Castro CA. Adherence to Subcutaneous Anti-Tumour Necrosis Factor Treatment in a Cohort of Patients with Rheumatoid Arthritis Before and After the Implementation of a Comprehensive Care Model. Biologics 2022; 16:199-209. [PMID: 36440060 PMCID: PMC9699109 DOI: 10.2147/btt.s385422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To assess, in a cohort of patients with rheumatoid arthritis (RA) treated with subcutaneous antitumor necrosis factor drugs (anti-TNFs), the levels of treatment adherence before and after implementing a comprehensive care model (CCM). PATIENTS AND METHODS An observational study including RA patients under treatment with subcutaneous anti-TNFs (adalimumab, etanercept, and golimumab) selected at convenience was performed; a sample size of 125 patients was calculated. The outcome variable was adherence assessed with the Compliance Questionnaire on Rheumatology (CQR19), measured before and after implementing a CCM. Descriptive and bivariate analyses were performed comparing adherence before and after applying the model (Wilcoxon and McNemar's Chi2 test). For multivariate analysis, a generalized linear model adjusted for covariates was performed, where the difference in the proportion of adherence was the outcome measure. RESULTS A total of 131 RA patients were followed-up for 24 months; average age was 62 years, and 83.9% were women. The median of DAS28 at the beginning of the follow-up was 2.32, and the HAQ was 0.25. At baseline, 87.8% were adherent; after 24 months, 96.2% were adherent according to CQR19. At the end of follow-up, adherence increased with the three types of anti-TNFs treatment. In a matched model adjusted for clinical variables, the CCM was estimated to produce a 9.4% increase in the total percentage of adherent patients. Additionally, a statistically significant increase of 4.5% in the percentage of adherent patients treated with golimumab compared with etanercept and adalimumab was found. CONCLUSION A CCM produced an important increase in the percentage of patients with rheumatoid arthritis adherent to treatment after 24 months of follow-up. It is noteworthy that Golimumab patients were more adherent when compared with other current anti-TNFs treatments.
Collapse
Affiliation(s)
| | - Guillermo Sánchez-Vanegas
- Scientific Direction Department, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogotá, Colombia
| | - Angélica Monterrosa-Blanco
- Research and Health Education Department, Comprehensive Solutions for Health Research and Education-SIIES, Bogotá, Colombia
| | | | - Manuel Rivero
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
| | | | - Omar-Javier Calixto
- Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia
| | | | - Carlos Alberto Castro
- Research and Health Education Department, Comprehensive Solutions for Health Research and Education-SIIES, Bogotá, Colombia
| |
Collapse
|
3
|
Almodovar R, Joven B, Rodríguez Almaraz E, Melchor S, Rabadán E, Villaverde V, Navío T, Cebrián Méndez L, Lojo Oliveira L, Prada A, González L, García Martos Á, Navarro-Compán V, Loza E, Zarco P. Comparative results of the implementation in daily practice of an evaluation checklist for patients with axial spondyloarthritis and psoriatic arthritis. ACTA ACUST UNITED AC 2020; 17:392-396. [PMID: 34301382 DOI: 10.1016/j.reumae.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyse and compare changes in the collection of clinical variables after the implementation in daily practice of an evaluation checklist for patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS An observational study was performed based on medical records review. The number and type of variables of the evaluation checklist in the medical records were collected. The first review was made before the implementation of the checklist, and the second one 6 months after the implementation (in different patients). A descriptive and bivariate analysis was carried out. RESULTS Six hospitals and 11 rheumatologists participated. A total of 83 and 68 medical records were reviewed before and after the implementation of the checklist. After the implementation, in the axSpA patients, a significant increase was recorded in alcohol consumption, diarrhoea or IBD and urethritis, diabetes mellitus, hyperlipidaemia, depression, obesity or gout/hyperuricaemia, weight, height, blood pressure, patient and physician global assessments of disease activity, BASDAI and DAS28. And, in the PsA patients, alcohol consumption, hypertension, diabetes mellitus, hyperlipidaemia, disease, gout/hyperuricaemia, thoracic expansion, cervical rotation, weight, height, blood pressure, patient and physician global assessments of disease, ASDAS, BASDAI, and BASFI were recorded. In general, there was a trend towards greater recording in axSpA compared with PsA. CONCLUSIONS The implementation of a specific checklist in daily practice improves the evaluation of patients with axSpA and PsA. More efforts are necessary to continue improving the evaluation of patients with axSpA, but especially of those with PsA.
Collapse
Affiliation(s)
- Raquel Almodovar
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Sheila Melchor
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Rabadán
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Virginia Villaverde
- Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Teresa Navío
- Servicio de Reumatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Alejandro Prada
- Servicio de Reumatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - Laura González
- Servicio de Reumatología, Hospital del Tajo, Aranjuez, Madrid, Spain
| | | | | | | | - Pedro Zarco
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| |
Collapse
|
4
|
Vivienne L, Michael S. Nurses' roles in the management of chronic inflammatory arthritis: a systematic review. Rheumatol Int 2018; 38:2027-36. [PMID: 30128732 DOI: 10.1007/s00296-018-4135-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/14/2018] [Indexed: 01/10/2023]
Abstract
In 2011 EULAR first published recommendations for the potential role of nurses in the management of patients with rheumatic diseases. To perform a literature update for the role of nurses in the management of chronic inflammatory arthritis (CIA) from 2010 to 2018. A systematic literature review (SLR) was performed according to the PRISMA guidelines, in accordance with the search strategies and eligibility criteria of the EULAR taskforce. The eligibility criteria were “inflammatory arthritis”, “interventions undertaken by nurses” and “relevant outcomes to answer the research questions”. Exclusion criteria were in itself contradictory outcomes, insufficient data, consideration if they did not clearly distinguish between nurses and health professionals or focused on chronic other than rheumatic diseases. Systematic reviews were classified as descriptive and excluded. Quality of selected trials was determined according to Oxford—levels of evidence 2009. A total of 48 articles and 10 abstracts were identified fulfilling the eligibility and exclusion criteria. Recommendation 1 has been well established in Europe so far. New evidence strengthens the recommendation 3, and—at least in part—recommendation 6. High evidence strengthens recommendation 4, especially for outpatients with low and stable disease activity. Some new evidence also exists for recommendations 7 and 8. This SLR reveals new evidence for the role of nurses in managing CIA patients since 2010, especially for RA-patients with low disease activity or in remission.
Collapse
|
5
|
Verhoef LM, Tweehuysen L, Hulscher ME, Fautrel B, den Broeder AA. bDMARD Dose Reduction in Rheumatoid Arthritis: A Narrative Review with Systematic Literature Search. Rheumatol Ther 2017; 4:1-24. [PMID: 28255897 DOI: 10.1007/s40744-017-0055-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction Although bDMARDs are effective in the treatment of RA, they are associated with dose-dependent side effects, patient burden, and high costs. Recently, many studies have investigated the possibility of discontinuing or tapering bDMARDs when patients have reached their treatment goal. The aim of this review is to provide a narrative overview of the existing evidence on bDMARD dose reduction and to provide answers to specific dose-reduction-related questions that are of interest to clinicians. Methods We systematically searched for relevant studies in four scientific databases. Furthermore, we screened the references of reviews and relevant studies. Results Our searches resulted in 45 original studies of bDMARD dose reduction in RA patients (15 RCTs and 30 observational studies). Current evidence shows that bDMARD dose reduction can be considered in all RA patients who achieve stable (e.g., ≥6 months) low disease activity or remission. The best strategies seem to be disease-activity-guided dose optimization and fixed dose reduction, since direct bDMARD discontinuation (without restarting) results in a high flare rate, worse physical functioning, and more joint damage. When tapering the bDMARD treatment of a patient, disease activity should be monitored closely, and if a flare occurs, the dose should be increased to the lowest effective dose. Current evidence shows that restarting bDMARD treatment is effective and safe. Unfortunately, no clear predictors of successful dose reduction have been identified so far. Conclusion The current evidence and rising healthcare costs urge that dose reduction should be considered for eligible patients. However, the decision to start dose reduction should be made in shared decision-making. Future research should focus not only on a better understanding of the effects of dose reduction on clinical outcomes but also on the perspectives of patients and physicians as well as the implementation of this new treatment principle. Electronic supplementary material The online version of this article (doi:10.1007/s40744-017-0055-5) contains supplementary material, which is available to authorized users.
Collapse
|