title: The use of tumour necrosis factor alpha-blockers in daily routine. An Austrian consensus project.
abstract: To define relevant disease parameters and their respective limits indicating the initiation of TNF-alpha-blockers in individual patients. Subsequently, to analyze retrospectively patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS), who started TNF-alpha inhibition in 2006. Points to consider, regarded relevant for individual treatment decisions as well as their assessment methods, were ascertained by experts' consensus applying the Delphi technique. Subsequently, these parameters' thresholds with respect to the initiation of a TNF-alpha-blocker were identified. Thereafter, the rheumatologists representing 12 centres all over Austria agreed to retrospectively analyze their patients started on a TNF-alpha-blocker in 2006. Experts' opinion regarding disease parameters relevant to initiate TNF-alpha-blockers in RA patients only slightly differed from those applied in clinical trials, but the parameters' threshold values were considerably lower. For PsA patients, some differences and for AS patients, considerable differences between experts' opinion and clinical studies appeared, which held also true for decisive parameters' means and thresholds. Six hundred and fifty patients, started on TNF-blockers in 2006, could be analyzed retrospectively, 408 RA patients (53.3 years mean, 340 females), 93 PsA patients (48.9 years mean, 59 males) and 149 AS patients AS (42.2 years mean, 108 males), representing approximately 25% of all Austrian patients initiated on a TNF-blocker in this respective year. Far more individualized, patient-oriented treatment approaches, at least in part, are applied in daily routine compared with those derived from clinical trials or recommendations from investigative rheumatologists.
authors.affiliation: Karl Landsteiner-Institute for Clinical Rheumatology, First and Second Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau, Landstrasse 18, Stockerau, 2000, Austria. burkhard.leeb@stockerau.lknoe.at
authors.forename: Burkhard F
authors.initials: BF
authors.lastname: Leeb
authors.forename: Elke
authors.initials: E
authors.lastname: Böttcher
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brezinschek
authors.forename: Christoph
authors.initials: C
authors.lastname: Czerwenka
authors.forename: Manfred
authors.initials: M
authors.lastname: Herold
authors.forename: Hans
authors.initials: H
authors.lastname: Hitzelhammer
authors.forename: Franz
authors.initials: F
authors.lastname: Mayrhofer
authors.forename: Rudolf
authors.initials: R
authors.lastname: Puchner
authors.forename: Franz
authors.initials: F
authors.lastname: Rainer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rintelen
authors.forename: Michael
authors.initials: M
authors.lastname: Schirmer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Stuby
authors.forename: Hans
authors.initials: H
authors.lastname: Bröll
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001317:Austria; D003657:Decision Making; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018124:Receptors, Tumor Necrosis Factor / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept