title: Singapore Chapter of Rheumatologists Consensus Statement on the Eligibility for Government Subsidy of Biologic Disease Modifying Antirheumatic Agents for Treatment of Rheumatoid Arthritis (RA).
abstract: BACKGROUND
  Up to 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional non-biologic disease modifying antirheumatic drugs (nbDMARDs), and may benefit from therapy with biologic DMARDs (bDMARDs). However, the high cost of bDMARDs limits their widespread use. The Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore aims to define clinical eligibility for government-assisted funding of bDMARDs for local RA patients.
  
  
  METHODS
  Evidence synthesis was performed by reviewing 7 published guidelines on use of biologics for RA. Using the modified RAND/UCLA Appropriateness Method (RAM), rheumatologists rated indications for therapies for different clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate the practice recommendations.
  
  
  RESULTS
  Ten recommendations including diagnosis of RA, choice of disease activity measure, initiation and continuation of bDMARD and option of first and second-line therapies were formulated. The panellists agreed that a bDMARD is indicated if a patient has (1) active RA with a Disease Activity Score in 28 joints (DAS28) score of ≥3.2, (2) a minimum of 6 swollen and tender joints, and (3) has failed a minimum of 2 nbDMARD combinations of adequate dose regimen for at least 3 months each. To qualify for continued biologic therapy, a patient must have (1) documentation of DAS28 every 3 months and (2) at least a European League Against Rheumatism (EULAR) moderate response by 6 months after commencement of therapy.
  
  
  CONCLUSIONS
  The recommendations developed by a formal group consensus method may be useful for clinical practice and guiding funding decisions by relevant authorities in making bDMARDs usage accessible and equitable to eligible patients in Singapore.
authors.affiliation: Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.
authors.forename: Gim Gee
authors.initials: GG
authors.lastname: Teng
authors.forename: Peter P
authors.initials: PP
authors.lastname: Cheung
authors.forename: Manjari
authors.initials: M
authors.lastname: Lahiri
authors.forename: Jane A
authors.initials: JA
authors.lastname: Clayton
authors.forename: Li Ching
authors.initials: LC
authors.lastname: Chew
authors.forename: Ee Tzun
authors.initials: ET
authors.lastname: Koh
authors.forename: Wei Howe
authors.initials: WH
authors.lastname: Koh
authors.forename: Tang Ching
authors.initials: TC
authors.lastname: Lau
authors.forename: Swee Cheng
authors.initials: SC
authors.lastname: Ng
authors.forename: Bernard Y
authors.initials: BY
authors.lastname: Thong
authors.forename: Archana R
authors.initials: AR
authors.lastname: Vasudevan
authors.forename: Jon K C
authors.initials: JK
authors.lastname: Yoong
authors.forename: Keng Hong
authors.initials: KH
authors.lastname: Leong
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005380:Financing, Government; D006801:Humans; D017410:Practice Guidelines as Topic; D012846:Singapore
chemical_list: D018501:Antirheumatic Agents