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Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted-synthetic therapy for the treatment of rheumatoid arthritis.
Int J Rheum Dis. 2020 Feb; 23(2):140-152.IJ

Abstract

INTRODUCTION

Approximately 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional-synthetic disease-modifying anti-rheumatic drugs (csDMARDs). However, widespread use of biologic DMARDs (bDMARDs) and targeted-synthetic (tsDMARDs) is limited by cost. We formulated updated recommendations for eligibility criteria for government-assisted funding of bDMARDs/tsDMARDs for RA patients in Singapore.

MATERIALS AND METHODS

Published guidelines regarding use of bDMARD and tsDMARDs were reviewed. We excluded those without a systematic literature review, formal consensus process or evidence grading. Separately, unpublished national reimbursement guidelines were included.

RESULTS

Eleven recommendations regarding choice of disease activity measure, initiation, order of selection and continuation of bDMARD/tsDMARDs were formulated. A bDMARD/tsDMARD is indicated if a patient has: (a) at least moderately active RA with a Disease Activity Score in 28 joints/erythrocyte sedimentation rate (DAS28-ESR) score of ≥3.2; (b) failed ≥2 csDMARD strategies, 1 of which must be a combination; (c) received an adequate dose regimen of ≥3 months for each strategy. For the first-line bDMARD/tsDMARD, either tumor necrosis factor inhibitors (TNFi), non-TNFi (abatacept, tocilizumab, rituximab), or tsDMARDs, may be considered. If a first-line TNFi fails, options include another TNFi, non-TNFi biologic or tsDMARDs. If a first-line non-TNFi biologic or tsDMARD fails, options include TNFi or another non-TNF biologic or tsDMARD. For continued bDMARD/tsDMARD subsidization, a patient must have a documented DAS28-ESR every 3 months and at least a moderate European League Against Rheumatism response by 6 months.

CONCLUSION

These recommendations are useful for guiding funding decisions, making bDMARD/tsDMARDs usage accessible and equitable in RA patients who fail csDMARDs.

Authors+Show Affiliations

Department of Medicine, Changi General Hospital, Singapore, Singapore.Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore.Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.Leong Keng Hong Arthritis and Medical Clinic, Singapore, Singapore.Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.Lui Centre for Arthritis & Rheumatology, Gleneagles Medical Centre, Singapore, Singapore.Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.Department of Medicine, Changi General Hospital, Singapore, Singapore.Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore.Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31859424

Citation

Leong, Joanna Wai Yee, et al. "Singapore Chapter of Rheumatologists Updated Consensus Statement On the Eligibility for Government Subsidization of Biologic and Targeted-synthetic Therapy for the Treatment of Rheumatoid Arthritis." International Journal of Rheumatic Diseases, vol. 23, no. 2, 2020, pp. 140-152.
Leong JWY, Cheung PP, Dissanayake S, et al. Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted-synthetic therapy for the treatment of rheumatoid arthritis. Int J Rheum Dis. 2020;23(2):140-152.
Leong, J. W. Y., Cheung, P. P., Dissanayake, S., Fong, W. W. S., Leong, K. H., Leung, Y. Y., Lim, A. Y. N., Lui, N. L., Manghani, M., Santosa, A., Sriranganathan, M. K., Suresh, E., Tan, T. C., Teng, G. G., & Lahiri, M. (2020). Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted-synthetic therapy for the treatment of rheumatoid arthritis. International Journal of Rheumatic Diseases, 23(2), 140-152. https://doi.org/10.1111/1756-185X.13762
Leong JWY, et al. Singapore Chapter of Rheumatologists Updated Consensus Statement On the Eligibility for Government Subsidization of Biologic and Targeted-synthetic Therapy for the Treatment of Rheumatoid Arthritis. Int J Rheum Dis. 2020;23(2):140-152. PubMed PMID: 31859424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted-synthetic therapy for the treatment of rheumatoid arthritis. AU - Leong,Joanna Wai Yee, AU - Cheung,Peter P, AU - Dissanayake,Sajeewani, AU - Fong,Warren Weng Seng, AU - Leong,Keng Hong, AU - Leung,Ying Ying, AU - Lim,Anita Yee Nah, AU - Lui,Nai Lee, AU - Manghani,Mona, AU - Santosa,Amelia, AU - Sriranganathan,Melonie Kannamma, AU - Suresh,Ernest, AU - Tan,Teck Choon, AU - Teng,Gim Gee, AU - Lahiri,Manjari, Y1 - 2019/12/19/ PY - 2019/07/10/received PY - 2019/10/29/revised PY - 2019/11/03/accepted PY - 2019/12/21/pubmed PY - 2019/12/21/medline PY - 2019/12/21/entrez KW - biologic KW - consensus KW - reimbursement KW - rheumatoid arthritis KW - subsidy KW - targeted-synthetic SP - 140 EP - 152 JF - International journal of rheumatic diseases JO - Int J Rheum Dis VL - 23 IS - 2 N2 - INTRODUCTION: Approximately 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional-synthetic disease-modifying anti-rheumatic drugs (csDMARDs). However, widespread use of biologic DMARDs (bDMARDs) and targeted-synthetic (tsDMARDs) is limited by cost. We formulated updated recommendations for eligibility criteria for government-assisted funding of bDMARDs/tsDMARDs for RA patients in Singapore. MATERIALS AND METHODS: Published guidelines regarding use of bDMARD and tsDMARDs were reviewed. We excluded those without a systematic literature review, formal consensus process or evidence grading. Separately, unpublished national reimbursement guidelines were included. RESULTS: Eleven recommendations regarding choice of disease activity measure, initiation, order of selection and continuation of bDMARD/tsDMARDs were formulated. A bDMARD/tsDMARD is indicated if a patient has: (a) at least moderately active RA with a Disease Activity Score in 28 joints/erythrocyte sedimentation rate (DAS28-ESR) score of ≥3.2; (b) failed ≥2 csDMARD strategies, 1 of which must be a combination; (c) received an adequate dose regimen of ≥3 months for each strategy. For the first-line bDMARD/tsDMARD, either tumor necrosis factor inhibitors (TNFi), non-TNFi (abatacept, tocilizumab, rituximab), or tsDMARDs, may be considered. If a first-line TNFi fails, options include another TNFi, non-TNFi biologic or tsDMARDs. If a first-line non-TNFi biologic or tsDMARD fails, options include TNFi or another non-TNF biologic or tsDMARD. For continued bDMARD/tsDMARD subsidization, a patient must have a documented DAS28-ESR every 3 months and at least a moderate European League Against Rheumatism response by 6 months. CONCLUSION: These recommendations are useful for guiding funding decisions, making bDMARD/tsDMARDs usage accessible and equitable in RA patients who fail csDMARDs. SN - 1756-185X UR - https://www.unboundmedicine.com/medline/citation/31859424/Singapore_Chapter_of_Rheumatologists_updated_consensus_statement_on_the_eligibility_for_government_subsidization_of_biologic_and_targeted_synthetic_therapy_for_the_treatment_of_rheumatoid_arthritis_ L2 - https://doi.org/10.1111/1756-185X.13762 DB - PRIME DP - Unbound Medicine ER -
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