Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans for Juvenile Idiopathic Arthritis-Associated and Idiopathic Chronic Anterior Uveitis
Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans for Juvenile Idiopathic Arthritis-Associated and Idiopathic Chronic Anterior Uveitis
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DOI：
10.1002/acr.23610
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发表时间：
2019-04-01
影响因子：
4.7
通讯作者：
Rabinovich, C. Egla
中科院分区：
文献类型：
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作者：
Angeles-Han, Sheila T.;Lo, Mindy S.;Rabinovich, C. Egla
目的：小儿慢性前葡萄膜炎（CAU），包括青少年特发性关节炎相关和特发性前葡萄膜炎，其全身免疫抑制治疗方法各不相同，难以确定最佳治疗方法。儿童关节炎和风湿病研究联盟（CARRA）为CAU制定了共识治疗计划（ctp），目的是减少实践的可变性，并允许将来使用比较有效性分析技术对治疗进行比较。方法：CARRA葡萄膜炎工作组由儿科风湿病学家、具有葡萄膜炎专业知识的眼科医生和一名外行顾问组成核心小组，对药物治疗进行文献综述，召开电话会议，并对CARRA成员进行基于病例的调查，以描述治疗实践。我们举行了3次面对面的共识会议，使用名义上的小组技术来制定ctp。结果调查确定了治疗实践可变性的领域。我们为CAU的治疗、病例定义和监测参数制定了2个ctp。第一个CTP针对的是未接受类固醇药物治疗的儿童，第二个针对的是开始生物治疗的儿童，可选择甲氨蝶呤、阿达木单抗和英夫利昔单抗。我们定义了核心数据集和结果测量，并在治疗开始后3个月和6个月收集数据。CARRA成员投票接受CTPs，支持率为95% （n = 233）。结论采用共识方法，为CAU的全身免疫抑制治疗制定了2个标准化的ctp。这些ctp并不意味着作为治疗指南，而是为CARRA研究网络内进一步的实用研究而设计的。在前瞻性比较有效性研究中使用这些ctp应通过确定最佳实践方案来改善结果。
Objective Systemic immunosuppressive treatment of pediatric chronic anterior uveitis (CAU), both juvenile idiopathic arthritis-associated and idiopathic anterior uveitis, varies, making it difficult to identify best treatments. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for CAU for the purpose of reducing practice variability and allowing future comparison of treatments using comparative effectiveness analysis techniques. Methods A core group of pediatric rheumatologists, ophthalmologists with uveitis expertise, and a lay advisor comprised the CARRA uveitis workgroup that performed a literature review on pharmacologic treatments, held teleconferences, and developed a case-based survey administered to the CARRA membership to delineate treatment practices. We held 3 face-to-face consensus meetings using nominal group technique to develop CTPs. Results The survey identified areas of treatment practice variability. We developed 2 CTPs for the treatment of CAU, case definitions, and monitoring parameters. The first CTP is directed at children who are naive to steroid-sparing medication, and the second at children initiating biologic therapy, with options for methotrexate, adalimumab, and infliximab. We defined a core data set and outcome measures, with data collection at 3 and 6 months after therapy initiation. The CARRA membership voted to accept the CTPs with a >95% approval (n = 233). Conclusion Using consensus methodology, 2 standardized CTPs were developed for systemic immunosuppressive treatment of CAU. These CTPs are not meant as treatment guidelines, but are designed for further pragmatic research within the CARRA research network. Use of these CTPs in a prospective comparison effectiveness study should improve outcomes by identifying best practice options.