Singapore Chapter of Rheumatologists consensus statement on the eligibility for government subsidy of biologic disease modifying anti-rheumatic agents for the treatment of psoriatic arthritis.
OBJECTIVE
In Singapore, patients with psoriatic arthritis (PsA) constitute a significant disease burden. There is good evidence for the efficacy of anti-tumor necrosis factor (anti-TNF) in PsA; however cost remains a limiting factor. Non-biologic disease modifying anti-rheumatic drugs (nbDMARDs) hence remain the first-line treatment option in PsA in spite of limited evidence. The Singapore Chapter of Rheumatologists aims to develop national guidelines for clinical eligibility for government-assisted funding of biologic disease modifying anti- rheumatic drugs (bDMARDs) for PsA patients in Singapore.


METHODS
Evidence synthesis was performed by reviewing seven published guidelines on use of biologics for PsA. Using the modified Research and Development/University of California at Los Angeles 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 were formulated relating to initiation, continuation and options of bDMARD therapy. The panellists agreed that a bDMARD is indicated if a patient has active PsA with at least five swollen and tender joints, digits or entheses and has failed two nbDMARD strategies at optimal doses for at least 3 months each. Any anti-TNF may be used and therapy may be continued if an adequate PsARC response is achieved by 3 months after commencement.


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 bDMARD usage accessible and equitable to eligible patients in Singapore.
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Manjari
M
Lahiri
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Gim-Gee
GG
Teng
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Peter P
PP
Cheung
Department of Medicine, Alexandra Hospital (Jurong Health), Singapore, Singapore.
Ernest
E
Suresh
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.
Faith L
FL
Chia
Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
Nai-Lee
NL
Lui
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Dow-Rhoon
DR
Koh
Koh Wei Howe Arthritis & Rheumatism Medical Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore.
Wei-Howe
WH
Koh
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.
Khai-Pang
KP
Leong
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Anita Y N
AYN
Lim
Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
Swee-Cheng
SC
Ng
Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
Julian
J
Thumboo
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Tang-Ching
TC
Lau
Leong Keng Hong Arthritis and Medical Clinic, Gleneagles Medical Centre, Singapore, Singapore.
Keng-Hong
KH
Leong
D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D032921:Consensus; D016527:Drug Costs / Q000331:legislation & jurisprudence; D004608:Eligibility Determination / Q000191:economics* / Q000331:legislation & jurisprudence; D005380:Financing, Government / Q000191:economics* / Q000331:legislation & jurisprudence; D033161:Government Regulation; D005102:Health Expenditures / Q000331:legislation & jurisprudence; D006801:Humans; D009313:National Health Programs / Q000191:economics* / Q000331:legislation & jurisprudence; D011050:Policy Making; D000072140:Rheumatologists
D018501:Antirheumatic Agents; D001688:Biological Products
clinical aspects (psoriatic arthritis); drug treatment (psoriatic arthritis); psoriatic arthritis