Clinical practice decision tree for the choice of the first disease modifying antirheumatic drug for very early rheumatoid arthritis: a 2004 proposal of the French Society of Rheumatology
Identifieur interne : 001D58 ( Main/Exploration ); précédent : 001D57; suivant : 001D59Clinical practice decision tree for the choice of the first disease modifying antirheumatic drug for very early rheumatoid arthritis: a 2004 proposal of the French Society of Rheumatology
Auteurs : X. Le Loët [France] ; J M Berthelot [France] ; A. Cantagrel [France] ; B. Combe [France] ; M. De Bandt [France] ; B. Fautrel [France] ; R M Flipo [France] ; F. Lioté [France] ; J F Maillefert [France] ; O. Meyer ; A. Saraux [France] ; D. Wendling [France] ; F. Guillemin [France]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2006-01.
English descriptors
- KwdEn :
- Teeft :
- American college, Antirheumatic, Antirheumatic drug, Antirheumatic drugs, Arthritis, Arthritis rheum, Bichat paris university hospital, Biological agents, Citrulline peptide antibodies, Clinical experience, Clinical situation, Clinical situations, Correspondence factor analysis, Decision tree, Delphi method, Disease activity, Dmard, Dmard characteristics, Dmard choice, Dmards, Early disease, Erythrocyte sedimentation rate, Expert panel, Final choice, First disease, First dmard, French society, Guideline, High disease activity, High level, Initial presence, Joint damage, Joint disease activity score, Leflunomide, Literature review, Medical history, Methotrexate, Nancy university hospital, Patient characteristics, Physician characteristics, Polyarthrite rhumatoide, Principal items, Prognostic factors, Radiographic damage, Ranking choices, Reactive protein, Recent onset, Recent reviews, Rheum, Rheumatoid, Rheumatoid arthritis, Rheumatoid arthritis activity, Rheumatoid factor, Rheumatoid factor positivity, Rheumatoid factor status, Rheumatology, Scenario, Second choice, Stpr experts, Strategies therapeutiques, Structural damage, Structural involvement, Swollen joints, Treatment options, Treatment strategy.
Abstract
Objective: To elaborate a clinical practice decision tree for the choice of the first disease modifying antirheumatic drug (DMARD) for untreated rheumatoid arthritis of less than six months’ duration. Methods: Four steps were employed: (1) review of published reports on DMARD efficacy against rheumatoid arthritis; (2) inventory of the information available to guide DMARD choice; (3) selection of the most pertinent information by 12 experts using a Delphi method; and (4) choice of DMARDs in 12 clinical situations defined by items selected in step 3 (28 joint disease activity score (DAS 28): ⩽3.2; >3.2 and ⩽5.1; >5.1; rheumatoid factor status (positive/negative); structural damage (with/without)—that is, 3×2×2). Thus, multiplied by all the possible treatment pairs, 180 scenarios were obtained and presented to 36 experts, who ranked treatment choices according to the Thurstone pairwise method. Results: Among the 77 items identified, 41 were selected as pertinent to guide the DMARD choice. They were reorganised into five domains: rheumatoid arthritis activity, factors predictive of structural damage; patient characteristics; DMARD characteristics; physician characteristics. In the majority of situations, the two top ranking DMARD choices were methotrexate and leflunomide. Etanercept was an alternative for these agents when high disease activity was associated with poor structural prognosis and rheumatoid factor positivity. Conclusions: Starting with simple scenarios and using the pairwise method, a clinical decision tree could be devised for the choice of the first DMARD to treat very early rheumatoid arthritis.
Url:
DOI: 10.1136/ard.2005.035436
Affiliations:
- France
- Bourgogne, Bourgogne-Franche-Comté, Franche-Comté, Grand Est, Haute-Normandie, Hauts-de-France, Languedoc-Roussillon, Lorraine (région), Midi-Pyrénées, Nord-Pas-de-Calais, Occitanie (région administrative), Pays de la Loire, Région Bretagne, Région Normandie, Île-de-France
- Besançon, Brest, Dijon, Lille, Montpellier, Nancy, Nantes, Paris, Rouen, Toulouse
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Le Loët</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Department of Rheumatology, Rouen University Hospital, Rouen</wicri:regionArea><placeName><region type="region">Région Normandie</region><region type="old region">Haute-Normandie</region><settlement type="city">Rouen</settlement></placeName></affiliation></author><author><name sortKey="Berthelot, J M" sort="Berthelot, J M" uniqKey="Berthelot J" first="J M" last="Berthelot">J M Berthelot</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Department of Rheumatology, Nantes University Hospital, Nantes</wicri:regionArea><placeName><region type="region">Pays de la Loire</region><region type="old region">Pays de la Loire</region><settlement type="city">Nantes</settlement></placeName></affiliation></author><author><name sortKey="Cantagrel, A" sort="Cantagrel, A" uniqKey="Cantagrel A" first="A" last="Cantagrel">A. Cantagrel</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Department of Rheumatology, Toulouse University Hospital, Toulouse</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Midi-Pyrénées</region><settlement type="city">Toulouse</settlement></placeName></affiliation></author><author><name sortKey="Combe, B" sort="Combe, B" uniqKey="Combe B" first="B" last="Combe">B. Combe</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Federation of Rheumatology, Montpellier University Hospital, Montpellier</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="De Bandt, M" sort="De Bandt, M" uniqKey="De Bandt M" first="M" last="De Bandt">M. De Bandt</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Department of Rheumatology, Bichat Paris University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Fautrel, B" sort="Fautrel, B" uniqKey="Fautrel B" first="B" last="Fautrel">B. Fautrel</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Department of Rheumatology, La Pitié Paris University Hospital</wicri:orgArea></affiliation></author><author><name sortKey="Flipo, R M" sort="Flipo, R M" uniqKey="Flipo R" first="R M" last="Flipo">R M Flipo</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Department of Rheumatology, Lille University Hospital, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Liote, F" sort="Liote, F" uniqKey="Liote F" first="F" last="Lioté">F. 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Meyer</name><affiliation><wicri:noCountry code="subField">Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Saraux, A" sort="Saraux, A" uniqKey="Saraux A" first="A" last="Saraux">A. Saraux</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Department of Rheumatology, Brest University Hospital, Brest</wicri:regionArea><placeName><region type="region">Région Bretagne</region><region type="old region">Région Bretagne</region><settlement type="city">Brest</settlement></placeName></affiliation></author><author><name sortKey="Wendling, D" sort="Wendling, D" uniqKey="Wendling D" first="D" last="Wendling">D. Wendling</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Department of Rheumatology, Besançon University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Guillemin, F" sort="Guillemin, F" uniqKey="Guillemin F" first="F" last="Guillemin">F. Guillemin</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>EA 344, Department of Public Health, Nancy University Hospital, Nancy</wicri:regionArea><placeName><region type="region">Grand Est</region><region type="old region">Lorraine (région)</region><settlement type="city">Nancy</settlement></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2006-01">2006-01</date><biblScope unit="volume">65</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="45">45</biblScope></imprint><idno type="ISSN">0003-4967</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>DAS 28, 28 joint disease activity score</term><term>DMARD choice</term><term>DMARD, disease modifying antirheumatic drug</term><term>decision tree</term><term>early rheumatoid arthritis</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>American college</term><term>Antirheumatic</term><term>Antirheumatic drug</term><term>Antirheumatic drugs</term><term>Arthritis</term><term>Arthritis rheum</term><term>Bichat paris university hospital</term><term>Biological agents</term><term>Citrulline peptide antibodies</term><term>Clinical experience</term><term>Clinical situation</term><term>Clinical situations</term><term>Correspondence factor analysis</term><term>Decision tree</term><term>Delphi method</term><term>Disease activity</term><term>Dmard</term><term>Dmard characteristics</term><term>Dmard choice</term><term>Dmards</term><term>Early disease</term><term>Erythrocyte sedimentation rate</term><term>Expert panel</term><term>Final choice</term><term>First disease</term><term>First dmard</term><term>French society</term><term>Guideline</term><term>High disease activity</term><term>High level</term><term>Initial presence</term><term>Joint damage</term><term>Joint disease activity score</term><term>Leflunomide</term><term>Literature review</term><term>Medical history</term><term>Methotrexate</term><term>Nancy university hospital</term><term>Patient characteristics</term><term>Physician characteristics</term><term>Polyarthrite rhumatoide</term><term>Principal items</term><term>Prognostic factors</term><term>Radiographic damage</term><term>Ranking choices</term><term>Reactive protein</term><term>Recent onset</term><term>Recent reviews</term><term>Rheum</term><term>Rheumatoid</term><term>Rheumatoid arthritis</term><term>Rheumatoid arthritis activity</term><term>Rheumatoid factor</term><term>Rheumatoid factor positivity</term><term>Rheumatoid factor status</term><term>Rheumatology</term><term>Scenario</term><term>Second choice</term><term>Stpr experts</term><term>Strategies therapeutiques</term><term>Structural damage</term><term>Structural involvement</term><term>Swollen joints</term><term>Treatment options</term><term>Treatment strategy</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective: To elaborate a clinical practice decision tree for the choice of the first disease modifying antirheumatic drug (DMARD) for untreated rheumatoid arthritis of less than six months’ duration. Methods: Four steps were employed: (1) review of published reports on DMARD efficacy against rheumatoid arthritis; (2) inventory of the information available to guide DMARD choice; (3) selection of the most pertinent information by 12 experts using a Delphi method; and (4) choice of DMARDs in 12 clinical situations defined by items selected in step 3 (28 joint disease activity score (DAS 28): ⩽3.2; >3.2 and ⩽5.1; >5.1; rheumatoid factor status (positive/negative); structural damage (with/without)—that is, 3×2×2). Thus, multiplied by all the possible treatment pairs, 180 scenarios were obtained and presented to 36 experts, who ranked treatment choices according to the Thurstone pairwise method. Results: Among the 77 items identified, 41 were selected as pertinent to guide the DMARD choice. They were reorganised into five domains: rheumatoid arthritis activity, factors predictive of structural damage; patient characteristics; DMARD characteristics; physician characteristics. In the majority of situations, the two top ranking DMARD choices were methotrexate and leflunomide. Etanercept was an alternative for these agents when high disease activity was associated with poor structural prognosis and rheumatoid factor positivity. Conclusions: Starting with simple scenarios and using the pairwise method, a clinical decision tree could be devised for the choice of the first DMARD to treat very early rheumatoid arthritis.</div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Bourgogne</li><li>Bourgogne-Franche-Comté</li><li>Franche-Comté</li><li>Grand Est</li><li>Haute-Normandie</li><li>Hauts-de-France</li><li>Languedoc-Roussillon</li><li>Lorraine (région)</li><li>Midi-Pyrénées</li><li>Nord-Pas-de-Calais</li><li>Occitanie (région administrative)</li><li>Pays de la Loire</li><li>Région Bretagne</li><li>Région Normandie</li><li>Île-de-France</li></region><settlement><li>Besançon</li><li>Brest</li><li>Dijon</li><li>Lille</li><li>Montpellier</li><li>Nancy</li><li>Nantes</li><li>Paris</li><li>Rouen</li><li>Toulouse</li></settlement></list><tree><noCountry><name sortKey="Meyer, O" sort="Meyer, O" uniqKey="Meyer O" first="O" last="Meyer">O. Meyer</name></noCountry><country name="France"><region name="Région Normandie"><name sortKey="Le Loet, X" sort="Le Loet, X" uniqKey="Le Loet X" first="X" last="Le Loët">X. Le Loët</name></region><name sortKey="Berthelot, J M" sort="Berthelot, J M" uniqKey="Berthelot J" first="J M" last="Berthelot">J M Berthelot</name><name sortKey="Cantagrel, A" sort="Cantagrel, A" uniqKey="Cantagrel A" first="A" last="Cantagrel">A. Cantagrel</name><name sortKey="Combe, B" sort="Combe, B" uniqKey="Combe B" first="B" last="Combe">B. Combe</name><name sortKey="De Bandt, M" sort="De Bandt, M" uniqKey="De Bandt M" first="M" last="De Bandt">M. De Bandt</name><name sortKey="Fautrel, B" sort="Fautrel, B" uniqKey="Fautrel B" first="B" last="Fautrel">B. Fautrel</name><name sortKey="Flipo, R M" sort="Flipo, R M" uniqKey="Flipo R" first="R M" last="Flipo">R M Flipo</name><name sortKey="Guillemin, F" sort="Guillemin, F" uniqKey="Guillemin F" first="F" last="Guillemin">F. Guillemin</name><name sortKey="Liote, F" sort="Liote, F" uniqKey="Liote F" first="F" last="Lioté">F. Lioté</name><name sortKey="Maillefert, J F" sort="Maillefert, J F" uniqKey="Maillefert J" first="J F" last="Maillefert">J F Maillefert</name><name sortKey="Saraux, A" sort="Saraux, A" uniqKey="Saraux A" first="A" last="Saraux">A. Saraux</name><name sortKey="Wendling, D" sort="Wendling, D" uniqKey="Wendling D" first="D" last="Wendling">D. Wendling</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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