title: Is there a role for TNFα antagonists in the treatment of SSc? EUSTAR expert consensus development using the Delphi technique.
abstract: OBJECTIVE
  To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists.
  
  
  METHODS
  An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc.
  
  
  RESULTS
  Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-α inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNF-α antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-α antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-α antagonists for arthritis associated with SSc.
  
  
  CONCLUSIONS
  Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication in SSc, although controlled clinical trials with TNF-α antagonists are needed before general recommendations can be given.
authors.affiliation: Department of Rheumatology, University of Erlangen-Nuremberg, Germany. joerg.distler@uk-erlangen.de
authors.forename: Joerg H W
authors.initials: JH
authors.lastname: Distler
authors.forename: Suzana
authors.initials: S
authors.lastname: Jordan
authors.forename: Paolo
authors.initials: P
authors.lastname: Airo
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Alegre-Sancho
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balbir Gurman
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.forename: Paola
authors.initials: P
authors.lastname: Caramaschi
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Carreira
authors.forename: Carlo
authors.initials: C
authors.lastname: Chizzolini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tuncay Duruöz
authors.forename: Dominique
authors.initials: D
authors.lastname: Farge-Bancel
authors.forename: Roger
authors.initials: R
authors.lastname: Hesselstrand
authors.forename: Florenzo
authors.initials: F
authors.lastname: Iannone
authors.forename: Filip
authors.initials: F
authors.lastname: De Keyser
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Kucharz
authors.forename: David
authors.initials: D
authors.lastname: Launay
authors.forename: Paloma
authors.initials: P
authors.lastname: García de la Peña Lefebvre
authors.forename: Olga
authors.initials: O
authors.lastname: Lukacova
authors.forename: Bianca
authors.initials: B
authors.lastname: Marasini
authors.forename: Duska
authors.initials: D
authors.lastname: Martinovic
authors.forename: João Francisco
authors.initials: JF
authors.lastname: Marques Neto
authors.forename: Mislav
authors.initials: M
authors.lastname: Radic
authors.forename: Simona
authors.initials: S
authors.lastname: Rednic
authors.forename: Gabriela
authors.initials: G
authors.lastname: Riemekasten
authors.forename: Josef
authors.initials: J
authors.lastname: Rovensky
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Seidel
authors.forename: Soner
authors.initials: S
authors.lastname: Senel
authors.forename: Vanessa
authors.initials: V
authors.lastname: Smith
authors.forename: Cord
authors.initials: C
authors.lastname: Sunderkötter
authors.forename: Evelien
authors.initials: E
authors.lastname: Ton
authors.forename: Jacob M
authors.initials: JM
authors.lastname: van Laar
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
authors.forename: Ulf
authors.initials: U
authors.lastname: Müller Ladner
authors.forename: Oliver
authors.initials: O
authors.lastname: Distler
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D001168:Arthritis / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D032921:Consensus; D003697:Delphi Technique; D018450:Disease Progression; D005355:Fibrosis; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects; D007249:Inflammation; D056687:Off-Label Use; D012595:Scleroderma, Systemic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha