Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted‐synthetic therapy for the treatment of rheumatoid arthritis

• Published in: International journal of rheumatic diseases Vol. 23; no. 2; pp. 140 - 152
• Main Authors: Leong, Joanna Wai Yee, Cheung, Peter P., Dissanayake, Sajeewani, Fong, Warren Weng Seng, Leong, Keng Hong, Leung, Ying Ying, Lim, Anita Yee Nah, Lui, Nai Lee, Manghani, Mona, Santosa, Amelia, Sriranganathan, Melonie Kannamma, Suresh, Ernest, Tan, Teck Choon, Teng, Gim Gee, Lahiri, Manjari
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2020
• Subjects: Arthritis, Rheumatoid - drug therapy; biologic; Biological Products - therapeutic use; Consensus; Eligibility Determination - methods; Erythrocyte sedimentation rate; Government Programs; Humans; Joint diseases; Literature reviews; Monoclonal antibodies; Patients; reimbursement; Rheumatoid arthritis; Rheumatology; Rituximab; Singapore; Societies, Medical; subsidy; targeted‐synthetic; Tumor necrosis factor; Tumor necrosis factor-TNF; Singapore; consensus; reimbursement; subsidy; targeted-synthetic; rheumatoid arthritis; biologic
• ISSN: 1756-1841; 1756-185X
• DOI: 10.1111/1756-185X.13762

Introduction Approximately 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional‐synthetic disease‐modifying anti‐rheumatic drugs (csDMARDs). However, widespread use of biologic DMARDs (bDMARDs) and targeted‐synthetic (tsDMARDs) is limited by cost. We formulated updated recommendations for eligibility criteria for government‐assisted funding of bDMARDs/tsDMARDs for RA patients in Singapore. Materials and Methods Published guidelines regarding use of bDMARD and tsDMARDs were reviewed. We excluded those without a systematic literature review, formal consensus process or evidence grading. Separately, unpublished national reimbursement guidelines were included. Results Eleven recommendations regarding choice of disease activity measure, initiation, order of selection and continuation of bDMARD/tsDMARDs were formulated. A bDMARD/tsDMARD is indicated if a patient has: (a) at least moderately active RA with a Disease Activity Score in 28 joints/erythrocyte sedimentation rate (DAS28‐ESR) score of ≥3.2; (b) failed ≥2 csDMARD strategies, 1 of which must be a combination; (c) received an adequate dose regimen of ≥3 months for each strategy. For the first‐line bDMARD/tsDMARD, either tumor necrosis factor inhibitors (TNFi), non‐TNFi (abatacept, tocilizumab, rituximab), or tsDMARDs, may be considered. If a first‐line TNFi fails, options include another TNFi, non‐TNFi biologic or tsDMARDs. If a first‐line non‐TNFi biologic or tsDMARD fails, options include TNFi or another non‐TNF biologic or tsDMARD. For continued bDMARD/tsDMARD subsidization, a patient must have a documented DAS28‐ESR every 3 months and at least a moderate European League Against Rheumatism response by 6 months. Conclusion These recommendations are useful for guiding funding decisions, making bDMARD/tsDMARDs usage accessible and equitable in RA patients who fail csDMARDs.