Consensus on the use of Rituximab in Rheumatoid Arthritis. A document with evidence based recommendations

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A document with evidence based recommendations" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "30" "paginaFinal" => "44" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Emilio Martín Mola, Blanca Hernández, Miriam García-Arias, José María Álvaro-Gracia, Alejandro Balsa, Juan Gómez-Reino, José L. 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"apellidos" => "Marenco de la Fuente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 7 => array:3 [ "nombre" => "Víctor" "apellidos" => "Martínez-Taboada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 8 => array:3 [ "nombre" => "José Andrés Román" "apellidos" => "Ivorra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 9 => array:3 [ "nombre" => "Raimon" "apellidos" => "Sanmartí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 10 => array:2 [ "colaborador" => "Expert Group on Rituximab" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología e i+D+I, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario de La Princesa, IIS Princesa, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Reumatología, Hospital Universitario de Valme, Sevilla, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínic, Barcelona, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consenso de uso de rituximab en artritis reumatoide. Un documento con recomendaciones basadas en la evidencia" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-10-06" "fechaAceptado" => "2010-11-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec112621" "palabras" => array:4 [ 0 => "Rheumatoid arthritis" 1 => "Rituximab" 2 => "Biologic therapy" 3 => "Consensus" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec112620" "palabras" => array:4 [ 0 => "Artritis reumatoide" 1 => "Rituximab" 2 => "Terapias biológicas" 3 => "Consenso" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionRituximab has been employed successfully for the treatment of Rheumatoid Arthritis (RA). However, its particular mechanism of action, as well as a lack of concrete guidelines for its management have generated doubts on its use. ObjectiveTo establish recommendations that facilitate the use of rituximab in common clinical practice. MethodsIn a first Delphi round, 9 expert rheumatologists got together to develop questions on those subjects generating most doubts on the efficacy and safety of the drug. These were adapted to perform a systematic review of the evidence, which was presented in a second meeting. Nominal groups were formed to respond to each question and give a recommendation. These recommendations were presented in a second Delphi round to a larger group of experts in rheumatology. Once again recommendations were discussed, modified and voted upon. Once approved, a vote on the degree of agreement for each recommendation was carried out. ResultsSeventeen recommendations were established, 10 regarding efficacy and 7 safety. All of the efficacy recommendations except 3 presented a good or moderate degree of evidence. Among the safety recommendations, 3 had a good or moderate degree of evidence while in the rest it was indirect, scarce or non-existent and a product of expert recommendation. The degree of agreement between experts was elevated for most of the recommendations. ConclusionsThese recommendations attempt to clear doubts on the use of rituximab and establish guidelines for its use in daily practice. Efficacy recommendations have a high degree of evidence, allowing the clinician to be guided in therapeutic decisions. Safety recommendations have a lower degree of evidence." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl rituximab se ha empleado con éxito en el tratamiento de la artritis reumatoide (AR). Sin embargo, su particular mecanismo de acción, así como la ausencia de pautas concretas en su manejo, hace que se hayan generado dudas sobre su utilización. ObjetivoEstablecer recomendaciones que faciliten el empleo de rituximab en la práctica clínica habitual. MétodosEn una primera ronda Delphi, se reunieron nueve reumatólogos expertos que desarrollaron preguntas sobre los temas con mayor duda sobre eficacia y seguridad del fármaco. Estas se adecuaron para hacer una revisión sistemática de la evidencia, que se presentó en una segunda reunión. Se formaron grupos nominales para dar respuesta a cada pregunta y emitir la recomendación. Estas recomendaciones fueron presentadas en una segunda ronda Delphi a un grupo ampliado de reumatólogos expertos. De nuevo se discutieron, se modificaron y se votaron las recomendaciones. Una vez aprobada cada recomendación, se votó el grado de acuerdo. ResultadosSe establecieron 17 recomendaciones: diez de eficacia y siete de seguridad. Todas las recomendaciones de eficacia, excepto tres, presentaron un nivel de evidencia bueno o moderado. Entre las recomendaciones de seguridad, tres presentaron un nivel de evidencia bueno o moderado, mientras que para el resto la evidencia fue indirecta, escasa o nula y son producto de las recomendaciones de los expertos. El grado de acuerdo entre expertos fue elevado para la mayoría de las recomendaciones. ConclusionesEstas recomendaciones pretenden aclarar dudas sobre el uso de rituximab y establecer pautas de empleo en la práctica clínica. Las recomendaciones de eficacia tienen un nivel de evidencia alto y permiten guiar al médico en decisiones terapéuticas. Las recomendaciones de seguridad tienen un nivel de evidencia menor.." ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "Annex 1 contains the list of researchers of the Expert Group on Rituximab." 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Consensus on the use of Rituximab in Rheumatoid Arthritis. A document with evidence based recommendations

Consenso de uso de rituximab en artritis reumatoide. Un documento con recomendaciones basadas en la evidencia

Emilio Martín Molaa,

Corresponding author

emartinmola.hulp@salud.madrid.org

Corresponding author.

, Blanca Hernándezb, Miriam García-Ariasa, José María Álvaro-Graciac, Alejandro Balsaa, Juan Gómez-Reinod, José L. Marenco de la Fuentee, Víctor Martínez-Taboadaf, José Andrés Román Ivorrag, Raimon Sanmartíh, Expert Group on Rituximab 1

a Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain

b Servicio de Reumatología e i+D+I, Hospital Universitario Virgen Macarena, Sevilla, Spain

c Hospital Universitario de La Princesa, IIS Princesa, Madrid, Spain

d Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain

e Unidad de Gestión Clínica de Reumatología, Hospital Universitario de Valme, Sevilla, Spain

f Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain

g Servicio de Reumatología, Hospital Universitario La Fe, Valencia, Spain

h Servicio de Reumatología, Hospital Clínic, Barcelona, Spain

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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rituximab has been employed successfully for the treatment of Rheumatoid Arthritis &#40;RA&#41;&#46; However&#44; its particular mechanism of action&#44; as well as a lack of concrete guidelines for its management have generated doubts on its use&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To establish recommendations that facilitate the use of rituximab in common clinical practice&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In a first Delphi round&#44; 9 expert rheumatologists got together to develop questions on those subjects generating most doubts on the efficacy and safety of the drug&#46; These were adapted to perform a systematic review of the evidence&#44; which was presented in a second meeting&#46; Nominal groups were formed to respond to each question and give a recommendation&#46; These recommendations were presented in a second Delphi round to a larger group of experts in rheumatology&#46; Once again recommendations were discussed&#44; modified and voted upon&#46; Once approved&#44; a vote on the degree of agreement for each recommendation was carried out&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Seventeen recommendations were established&#44; 10 regarding efficacy and 7 safety&#46; All of the efficacy recommendations except 3 presented a good or moderate degree of evidence&#46; Among the safety recommendations&#44; 3 had a good or moderate degree of evidence while in the rest it was indirect&#44; scarce or non-existent and a product of expert recommendation&#46; The degree of agreement between experts was elevated for most of the recommendations&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">These recommendations attempt to clear doubts on the use of rituximab and establish guidelines for its use in daily practice&#46; Efficacy recommendations have a high degree of evidence&#44; allowing the clinician to be guided in therapeutic decisions&#46; Safety recommendations have a lower degree of evidence&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El rituximab se ha empleado con &#233;xito en el tratamiento de la artritis reumatoide &#40;AR&#41;&#46; Sin embargo&#44; su particular mecanismo de acci&#243;n&#44; as&#237; como la ausencia de pautas concretas en su manejo&#44; hace que se hayan generado dudas sobre su utilizaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Establecer recomendaciones que faciliten el empleo de rituximab en la pr&#225;ctica cl&#237;nica habitual&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En una primera ronda Delphi&#44; se reunieron nueve reumat&#243;logos expertos que desarrollaron preguntas sobre los temas con mayor duda sobre eficacia y seguridad del f&#225;rmaco&#46; Estas se adecuaron para hacer una revisi&#243;n sistem&#225;tica de la evidencia&#44; que se present&#243; en una segunda reuni&#243;n&#46; Se formaron grupos nominales para dar respuesta a cada pregunta y emitir la recomendaci&#243;n&#46; Estas recomendaciones fueron presentadas en una segunda ronda Delphi a un grupo ampliado de reumat&#243;logos expertos&#46; De nuevo se discutieron&#44; se modificaron y se votaron las recomendaciones&#46; Una vez aprobada cada recomendaci&#243;n&#44; se vot&#243; el grado de acuerdo&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se establecieron 17 recomendaciones&#58; diez de eficacia y siete de seguridad&#46; Todas las recomendaciones de eficacia&#44; excepto tres&#44; presentaron un nivel de evidencia bueno o moderado&#46; Entre las recomendaciones de seguridad&#44; tres presentaron un nivel de evidencia bueno o moderado&#44; mientras que para el resto la evidencia fue indirecta&#44; escasa o nula y son producto de las recomendaciones de los expertos&#46; El grado de acuerdo entre expertos fue elevado para la mayor&#237;a de las recomendaciones&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estas recomendaciones pretenden aclarar dudas sobre el uso de rituximab y establecer pautas de empleo en la pr&#225;ctica cl&#237;nica&#46; Las recomendaciones de eficacia tienen un nivel de evidencia alto y permiten guiar al m&#233;dico en decisiones terap&#233;uticas&#46; Las recomendaciones de seguridad tienen un nivel de evidencia menor&#46;&#46;</p>"
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/S2173-5743(11)70006-5

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2020 January	4	0	4
2019 September	5	0	5
2019 June	1	0	1
2019 March	2	0	2
2019 January	1	0	1
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2018 March	29	15	44
2018 February	17	4	21
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2016 August	28	6	34
2016 July	20	3	23
2016 February	4	6	10
2016 January	1	0	1
2015 December	5	0	5
2015 October	1	0	1
2015 September	2	0	2
2015 August	0	12	12
2015 July	22	5	27
2015 June	27	9	36
2015 May	41	20	61
2015 April	35	12	47
2015 March	35	11	46
2015 February	17	9	26
2015 January	34	12	46
2014 December	49	17	66
2014 November	44	18	62
2014 October	27	24	51
2014 September	28	16	44
2014 August	36	14	50
2014 July	25	18	43
2014 June	56	15	71
2014 May	44	13	57
2014 April	27	11	38
2014 March	53	20	73
2014 February	38	11	49
2014 January	37	26	63
2013 December	31	11	42
2013 November	30	11	41
2013 October	42	20	62
2013 September	55	15	70
2013 August	39	24	63
2013 July	48	13	61
2013 June	35	18	53
2013 May	43	20	63
2013 April	33	20	53
2013 March	29	22	51
2013 February	28	21	49
2013 January	26	9	35
2012 December	35	16	51
2012 November	15	17	32
2012 October	12	13	25
2012 September	10	5	15
2012 July	1	0	1
2012 June	4	0	4
2012 April	4	0	4
2012 March	11	0	11
2012 February	2	0	2
2012 January	3	0	3
2011 December	5	0	5
2011 November	9	0	9
2011 October	4	0	4
2011 September	2	0	2
2011 August	2	0	2
2011 July	1	0	1
2011 June	5	0	5
2011 May	2	0	2
2011 April	2	0	2
2011 March	3	0	3
2011 January	12	0	12

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