Implementation of protocolized tight control and biological dose optimization in daily clinical practice: results of a pilot study

Objectives: To assess the effects of education, guideline development, and individualized treatment advice on rheumatologist adherence to tight control-based treatment and biological dose optimization in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthropathy (SpA) patients. Me...

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Bibliographic Details
Published in:	Scandinavian journal of rheumatology Vol. 46; no. 2; pp. 152 - 155
Main Authors:	Lesuis, N, Verhoef, LM, Nieboer, LM, Bruyn, GA, Baudoin, P, van Vollenhoven, RF, Hulscher, MEJL, van den Hoogen, FHJ, den Broeder, AA
Format:	Journal Article
Language:	English
Published:	England Taylor & Francis 04-03-2017
Subjects:	Adult Aged Antirheumatic Agents - therapeutic use Arthritis, Psoriatic - drug therapy Arthritis, Rheumatoid - drug therapy Clinical Trials as Topic Female Humans Male Medicin och hälsovetenskap Middle Aged Pilot Projects Spondylarthropathies - drug therapy
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Summary:	Objectives: To assess the effects of education, guideline development, and individualized treatment advice on rheumatologist adherence to tight control-based treatment and biological dose optimization in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthropathy (SpA) patients. Method: This pilot study, among two rheumatologists and two specialized nurses in a general hospital, combined education, feedback, local guideline development, and individualized treatment advice. Outcomes (baseline and 1 year post-intervention) were the percentage of patients with a Disease Activity Score in 28 joints (DAS28) or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured during the visit, mean DAS28/BASDAI, and the percentage of patients using a reduced biological dose. DAS28 outcomes only applied to RA and PsA patients, BASDAI outcomes only applied to SpA patients whereas outcomes on biological dose applied to all patients. Results: A total of 232 patients (67% RA, 15% PsA, 18% SpA; 58% female, mean age 56 ± 15 years) were included in the study. The percentage of DAS28 and BASDAI measurements performed increased after the intervention [DAS28 15-51%, odds ratio (OR) 3.3, 95% confidence interval (CI) 2.1-5.5; BASDAI 23-50%, OR 2.2, 95% CI 1.0-5.5], with mean DAS28 and BASDAI scores remaining similar (DAS28: mean difference 0.1, 95% CI −0.3 to 0.5; BASDAI: mean difference 0.03, 95% CI −1.8 to 1.9). Use of a reduced biological dose increased from 10% to 61% (OR 3.9, 95% CI 2.4-6.5). Conclusions: A multicomponent intervention strategy aimed at rheumatologists can lead to improved adherence to tight control-based treatment and a reduction in the use of biologicals in RA, SpA, and PsA patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0300-9742 1502-7732 1502-7732
DOI:	10.1080/03009742.2016.1194457