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Appropriateness of clinical criteria for the use of symptomatic slow-acting drug for osteoarthritis (SYSADOA). A Delphi method consensus initiative among experts in Italy.

Abstract

BACKGROUND

OsteoArthritis (OA) is a theme currently representing an emerging topic for its increasing incidence. It is well known that it is a chronic disease that could lead to important long-lasting disability; this generates increasing costs for the health care system. OA treatment options vary: localization, aetiology, grading and symptomatology should be considered before choosing the most adequate therapy. Currently, a modern approach to managing OA involves SYmptomatic Slow Acting Drugs in Osteo-Arthritis (SYSADOAs). However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin, not all of them are supported by clinical evidence. Recently the European Society for Clinical and Economic aspects of Osteoporosis, Osteoarthritis and musculoskeletal diseases (ESCEO), produced an evidenced based document providing practitioners with the latest clinical and economic informations, thereby allowing them to optimize the management of knee OA. According to this report, only crystalline glucosamine sulphate and the pharmaceutical-grade chondroitin sulphate are considered as effective in the first line approach to treating knee OA as an alternative drug to acetaminophen. However, some OA guidelines do not agree are not concordant in recommending the use of SYSADOA, perhaps because they are generally considered as a class and distinctions among formulations aren't made.

AIM

Aim of this study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile in using SYSADOA.

DESIGN

Delphi method Consenus Statement.

POPULATION

Italian Physicians having expertise in Osteoarthritis management.

METHODS

A committee of 11 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Sixty-three clinicians from a large number of Italian medical centres specialized in osteoarthritis management took part in a Delphi process wich was aimed at obtaining consensus statements among the participants.

RESULTS

Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical devices choice; treatment efficacy.

CONCLUSIONS

Results from the Italian consensus on appropriateness of OA therapies in osteoarthritis seems to be in line with the stepwise approach proposed by the ESCEO algorithm, where crystalline glucosamine sulphate shows greater clinical efficacy than other glucosamine-based formulations, according to several independent meta-analyses.

CLINICAL REHABILITATION IMPACT

This study may be used as a practical reference tool to help Italian physicians treat osteoarthritis patients using SYSADOA.

Links

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  • Authors+Show Affiliations

    ,

    Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy - andrea.bernetti@uniroma1.it.

    ,

    Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.

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    Department of Orthopedic Science, Sapienza University, Rome, Italy.

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    Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.

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    Department of Orthopedic Science, Sapienza University, Rome, Italy.

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    Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy.

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    Drug Addiction and Clinical Pharmacology Unit, University Hospital Umberto I, Sapienza University of Rome, Rome, Italy.

    ,

    San Pietro Fatebenefratelli Hospital, Rome, Italy.

    ,

    ANMAR - Associazione Nazionale Malati Reumatici Onlus, Turin, Italy.

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    Department of Orthopedics and Traumatology, Sport Clinique, Rome, Italy.

    ,

    Università LUISS, Rome, Italy.

    Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31106560

    Citation

    Bernetti, Andrea, et al. "Appropriateness of Clinical Criteria for the Use of Symptomatic Slow-acting Drug for Osteoarthritis (SYSADOA). a Delphi Method Consensus Initiative Among Experts in Italy." European Journal of Physical and Rehabilitation Medicine, 2019.
    Bernetti A, Mangone M, Villani C, et al. Appropriateness of clinical criteria for the use of symptomatic slow-acting drug for osteoarthritis (SYSADOA). A Delphi method consensus initiative among experts in Italy. Eur J Phys Rehabil Med. 2019.
    Bernetti, A., Mangone, M., Villani, C., Alviti, F., Valeo, M., Grassi, M. C., ... Paoloni, M. (2019). Appropriateness of clinical criteria for the use of symptomatic slow-acting drug for osteoarthritis (SYSADOA). A Delphi method consensus initiative among experts in Italy. European Journal of Physical and Rehabilitation Medicine, doi:10.23736/S1973-9087.19.05633-8.
    Bernetti A, et al. Appropriateness of Clinical Criteria for the Use of Symptomatic Slow-acting Drug for Osteoarthritis (SYSADOA). a Delphi Method Consensus Initiative Among Experts in Italy. Eur J Phys Rehabil Med. 2019 May 15; PubMed PMID: 31106560.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Appropriateness of clinical criteria for the use of symptomatic slow-acting drug for osteoarthritis (SYSADOA). A Delphi method consensus initiative among experts in Italy. AU - Bernetti,Andrea, AU - Mangone,Massimiliano, AU - Villani,Ciro, AU - Alviti,Federica, AU - Valeo,Massimo, AU - Grassi,Maria Caterina, AU - Migliore,Alberto, AU - Viora,Ugo, AU - Adriani,Ezio, AU - Quirino,Nicola, AU - Fioravanti,Antonella, AU - Paoloni,Marco, Y1 - 2019/05/15/ PY - 2019/5/21/entrez JF - European journal of physical and rehabilitation medicine JO - Eur J Phys Rehabil Med N2 - BACKGROUND: OsteoArthritis (OA) is a theme currently representing an emerging topic for its increasing incidence. It is well known that it is a chronic disease that could lead to important long-lasting disability; this generates increasing costs for the health care system. OA treatment options vary: localization, aetiology, grading and symptomatology should be considered before choosing the most adequate therapy. Currently, a modern approach to managing OA involves SYmptomatic Slow Acting Drugs in Osteo-Arthritis (SYSADOAs). However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin, not all of them are supported by clinical evidence. Recently the European Society for Clinical and Economic aspects of Osteoporosis, Osteoarthritis and musculoskeletal diseases (ESCEO), produced an evidenced based document providing practitioners with the latest clinical and economic informations, thereby allowing them to optimize the management of knee OA. According to this report, only crystalline glucosamine sulphate and the pharmaceutical-grade chondroitin sulphate are considered as effective in the first line approach to treating knee OA as an alternative drug to acetaminophen. However, some OA guidelines do not agree are not concordant in recommending the use of SYSADOA, perhaps because they are generally considered as a class and distinctions among formulations aren't made. AIM: Aim of this study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile in using SYSADOA. DESIGN: Delphi method Consenus Statement. POPULATION: Italian Physicians having expertise in Osteoarthritis management. METHODS: A committee of 11 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Sixty-three clinicians from a large number of Italian medical centres specialized in osteoarthritis management took part in a Delphi process wich was aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical devices choice; treatment efficacy. CONCLUSIONS: Results from the Italian consensus on appropriateness of OA therapies in osteoarthritis seems to be in line with the stepwise approach proposed by the ESCEO algorithm, where crystalline glucosamine sulphate shows greater clinical efficacy than other glucosamine-based formulations, according to several independent meta-analyses. CLINICAL REHABILITATION IMPACT: This study may be used as a practical reference tool to help Italian physicians treat osteoarthritis patients using SYSADOA. SN - 1973-9095 UR - https://www.unboundmedicine.com/medline/citation/31106560/Appropriateness_of_clinical_criteria_for_the_use_of_symptomatic_slow_acting_drug_for_osteoarthritis__SYSADOA___A_Delphi_method_consensus_initiative_among_experts_in_Italy_ L2 - https://www.minervamedica.it/index2.t?show=R33Y9999N00A19051503 DB - PRIME DP - Unbound Medicine ER -