Abstract
Objective To reach a consensus on the instruments to be used in clinical practice to evaluate the effectiveness of biological disease-modifying antirheumatic drugs (bDMARD) treatment in PsA patients in the short-medium term (3-6 months), and to establish the minimum health outcomes for treatment continuation.
Methods A two-round Delphi questionnaire was developed based on both the information gathered in the literature review and four discussion groups. The suitability and feasibility of the proposed sets of instruments were assessed on a 7-point Likert scale. Consensus was established when at least 75% of healthcare professionals (HCPs) reached agreement. To define a minimum health outcome in order to continue treatment a combination of four disease activity states and three health-related quality of life states were defined for three hypothetical patient profiles. HCPs were given a dichotomous choice (“yes/no”) in response to whether they would continue treatment in each case.
Results 106 HCPs completed the second round. Consensus was reached on the use of: 1) Disease Activity in Psoriatic Arthritis (DAPSA) + Psoriatic Arthritis Impact of Disease (PsAID-12) or Minimal Disease Activity (MDA) + PsAID-12 + C-reactive protein, in peripheral PsA; and 2) Ankylosing Spondylitis Disease Activity Score (ASDAS) + PsAID-12, in axial PsA. Health outcomes considered sufficient to continue treatment were stricter for bDMARDs-naïve patients than for patients who failed several bDMARDs.
Conclusion To the best of our knowledge, this is the first multi-disciplinary consensus on a set of outcomes for the evaluation of bDMARDs effectiveness in PsA, in routine clinical practice.
