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Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore
Author(s) -
Phang Kee Fong,
Lahiri Manjari,
Fong Warren Weng Seng,
Leong Keng Hong,
Leung Ying Ying,
Lim Anita Yee Nah,
Lui Nai Lee,
Manghani Mona,
Tan Teck Choon,
Santosa Amelia,
Sriranganathan Melonie Kannamma,
Suresh Ernest,
Teng Gim Gee,
Cheung Peter P.
Publication year - 2020
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13744
Subject(s) - medicine , antirheumatic drugs , axial spondyloarthritis , ankylosing spondylitis , delphi method , infliximab , disease , physical therapy , subsidy , etanercept , antirheumatic agents , family medicine , intensive care medicine , tumor necrosis factor alpha , economics , market economy , statistics , mathematics , sacroiliitis
Aims The field of axial spondyloarthritis (axSpA) has undergone significant changes recently in particular with disease classification, assessment of disease activity and increased treatment options for biologics. In order to reflect these developments, we aimed to update the local consensus recommendations for subsidization of biologics. Methods A modified Delphi approach was used. Six published guidelines from major rheumatology societies and healthcare authorities on axSpA were reviewed. Findings were synthesized and used in formulating updated recommendation statements. Recommendations were rated by 10 practicing rheumatologists in Singapore. Consensus was reached if there was more than 70% agreement or disagreement. Results Ten statements achieved consensus. Patients may be considered for subsidization of biologic therapy if they fulfill the Assessment of Spondyloarthritis International Society or modified New York criteria, with persistently active disease (defined either by Ankylosing Spondylitis Disease Activity Score ≥ 2.1 or Bath Spondylitis Disease Activity Index ≥ 4), despite 4 weeks of full‐dose non‐steroidal anti‐inflammatory drugs and regular exercise. Either tumor necrosis factor inhibitors or interleukin 17 inhibitors may be used as first‐line therapy, and should be continued if adequate response is achieved at 6 months. Conclusion Recommendation statements were formulated through a formal consensus process by local experts with a view to assist relevant authorities in funding considerations and for use in clinical practice.