The ARA is collaborating with eight other organisations to create the Targeted Therapies Alliance – a group led by NPS MedicineWise that has won the Value in Prescribing bDMARDs Program grant from the federal government to optimise health and economic outcomes for biologic DMARD use.
The group is working to create a comprehensive suite of evidence-based and data-driven resources and activities for consumers, specialist prescribers and health professionals (pharmacists and specialist nurses).
Access to the information developed by the Targeted Therapies Alliance will be promoted and made available through the NPS MedicineWise website at the following link; https://www.nps.org.au/bdmards as well as the ARA website.
All ARA members were invited to be involved and there is a large number who have committed their time to the development and review of the resources. To date 17 rheumatologists and 2 rheumatology nurses have been involved as members of the Stakeholder Panel, interviews, workshops, reviews and user testing of resources.
Dr Paul Kubler, a rheumatologist who has been involved in developing and reviewing several of the resources, said, “It’s great to be involved with a multidisciplinary group to develop tools to assist patients in talking with their specialist about treatment decisions and achieving their goals.”
Some of these resources and activities are mentioned below in more detail.
PBS Practice Review
The first of these resources, the PBS Practice Review, will be available in October 2020. The Review is being sent to rheumatologists and immunologists who prescribe DMARDs for rheumatoid arthritis and presents individual PBS prescribing data compared to national data.
Living guideline for rheumatic diseases
As the number of available b/tsDMARDs increases, along with evidence regarding comparative efficacy, there is a growing need for easily accessible up-to-date information for prescribers.
To fill this knowledge gap, the ARA is working with the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network; https://anzmusc.org/ to create a living guideline for the pharmacological management of rheumatic diseases – rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthropathies (Axial SpA).
In the living guideline individual recommendations will be updated in near-real time as new evidence emerges.
The optimisation of evidence-based management of rheumatic diseases, including use of DMARDs, is expected to improve health outcomes for individuals with these conditions.
A priority list of questions generated by members of the ARA will inform the choice of questions addressed by the guideline.
The top 10 questions ranked by ARA members incorporated a number of important themes.
Many of the top questions related to the use of DMARDs, ranging from the best choice of DMARD in patients with early undifferentiated arthritis, to those who have failed to respond to b/tsDMARDs, and when to switch therapies.
The question of when and how to down-titrate b/tsDMARDs in patients who are in remission or low disease activity ranked highly and will form the basis of the first living recommendations. There was also an emphasis on the choice of DMARDs in specific populations, including those with co-morbidities and women who are pregnant or breastfeeding.
Other topics that ranked in the top 10 included the approach to vaccination, the use of glucocorticoids, and the management of persistent pain in RA.
A series of webinars and podcasts will be hosted by the ARA in 2021 as these guidelines are completed.
b/tsDMARD down-titration algorithm
The Targeted Therapies Alliance is also working on a b/tsDMARD down-titration algorithm which is a clinical decision support tool for rheumatologists to assess RA patients in persistent remission or low disease activity. The algorithm will include information on the patient’s suitability to down-titrate, shared decision making and the management of down-titration.
A patient decision aid, patient action plan and factsheets are being developed by NPS MedicineWise in consultation with Arthritis Australia, ARA and ANZMUSC.
The patient decision aid, designed to be used by patients in conjunction with their rheumatologist, aims to facilitate shared decision making by providing information on the down-titration process for rheumatoid arthritis, (including risks and benefits). It also includes a section for patients and health professionals to work through and clarify the patient’s values, preferences and other personal factors to consider when making decisions on down-titration.
The patient action plan aims to facilitate goal setting, self-management and monitoring for patients on low-dose methotrexate and is also designed to be used by patients in conjunction with their rheumatologist.
Factsheets will focus on the patient journey for RA, PsA and Axial SpA, flares and down-titration.
Links to existing factsheets and consumer web content on reputable websites will also be provided to consumers as part of the b/tsDMARDs program.
CATAG low dose methotrexate position statement
This position statement will provide guidance to a range of stakeholders on the safe dispensing and administration of low-dose methotrexate – oral tablets and pre-filled (or pre-prepared) subcutaneous injections for individual patients.
We expect this resource to be of assistance to Drug and Therapeutics Committees, Medicines Advisory Committees or equivalent, Medication Safety committees, hospital policy makers, Residential Aged Care Facilities, community pharmacies and health professionals.
Updates on the progress of the Targeted Therapies Alliance will be provided in each ARA e-news to keep all ARA members informed.
Overall, the Targeted Therapies Alliance will deliver useful resources that will optimise b/tsDMARD prescribing.