Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs: Part II Safety
Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs: Part II Safety
复制标题
DOI：
10.3899/jrheum.120165
复制
发表时间：
2012-08-01
影响因子：
3.9
通讯作者：
Bykerk, Vivian
中科院分区：
文献类型：
--
作者：
Bombardier, Claire;Hazlewood, Glen S.;Bykerk, Vivian
目标。加拿大风湿病协会（CRA）已经制定了两部分关于类风湿关节炎（RA）的传统和生物疾病缓解抗风湿药物（DMARD）的药理学管理建议。第二部分，重点介绍了传统和生物DMARD治疗类风湿性关节炎患者的具体安全性。根据国家需求评估调查的结果，先验地确定了关键问题。在Medline、Embase和CINAHL数据库中对2000年1月至2010年6月期间发表的所有关于传统和生物DMARD治疗类风湿性关节炎患者的临床实践指南和共识声明进行了系统回顾，并补充了包括相关公共卫生指南在内的“灰色文献”搜索。对上市后监测和RA注册研究进行系统回顾，以适时更新纳入的指南文献综述。指南质量由2位审稿人独立评估。来自观察性研究和随机试验的指南特征、建议和支持性证据被合成为证据表。工作组对使用改进的德尔菲技术的建议进行了投票。针对风湿病学家、其他类风湿性关节炎药物治疗的主要处方医师和类风湿性关节炎患者，提出了13项建议，包括围手术期护理、生物DMARD开始前的潜伏性结核感染筛查、最佳疫苗接种实践以及具有活动性或恶性肿瘤病史的类风湿性关节炎患者的治疗。这些建议是在综合国际类风湿性关节炎和公共卫生指南、支持性证据和加拿大卫生系统背景下的专家共识的基础上制定的。它们旨在帮助促进最佳实践并改善RA患者的医疗保健服务。（首次发布2012年6月15日；J Rheumatol 2012;39:1583-602; doi:10.3899/ jrheumat. 120165）
Objective. The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part II, focusing on specific safety aspects of treatment with traditional and biologic DMARD in patients with RA, is reported here.Methods. Key questions were identified a priori based on results of a national needs-assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and was supplemented with a "grey literature" search including relevant public health guidelines. Systematic reviews of postmarketing surveillance and RA registry studies were performed to update included guideline literature reviews as appropriate. Guideline quality was independently assessed by 2 reviewers. Guideline characteristics, recommendations, and supporting evidence from observational studies and randomized trials were synthesized into evidence tables. The working group voted on recommendations using a modified Delphi technique.Results. Thirteen recommendations addressing perioperative care, screening for latent tuberculosis infection prior to the initiation of biologic DMARD, optimal vaccination practices, and treatment of RA patients with active or a history of malignancy were developed for rheumatologists, other primary prescribers of RA drug therapies, and RA patients.Conclusion. These recommendations were developed based on a synthesis of international RA and public health guidelines, supporting evidence, and expert consensus in the context of the Canadian health system. They are intended to help promote best practices and improve healthcare delivery for persons with RA. (First Release June 15 2012; J Rheumatol 2012;39:1583-602; doi:10.3899/jrheum.120165)