title: Biologic Disease-modifying antirheumatic drug attributes in the first lines of treatment of rheumatoid arthritis. 2015 ACORDAR project.
abstract: OBJECTIVE
  To date, between 17% and 35% of patients with rheumatoid arthritis (RA) do not respond as expected to the initial biological therapy. The objective of this project is to recognize and weigh the attributes of biologic DMARD (bDMARD) to identify the most appropriate for each case, in the first lines of treatment of RA (after inadequate response to at least one synthetic DMARD or previous bDMARD).
  
  
  METHODS
  To recognize the possible attributes that could define the bDMARD, we performed a systematic search of the literature that recognized the possible attributes involving general aspects, pharmacology, efficacy, safety, management, and cost. Then a Delphi process was conducted with two rounds among a group of selected expert rheumatologists in the management of RA indicating the degree of agreement with the attributes identified in the literature. The project was completed between February and September 2015, indicating the degree of importance that was ascribed to each attribute. Two criteria were applied to determine the consistency of results: 1) based on the median and interquartile range; and 2) on the simultaneous compliance with mean, median, standard deviation, interquartile range and coefficient of variation. The agreement and final ratification of the expert panel were also determined.
  
  
  RESULTS
  Eighty-three Spanish rheumatologists participated and completed both rounds of the Delphi process. In no case was the importance of the 77 attributes identified considered to be low; 75 of 77 (97.4%) were considered highly important and 76 of 77 (98.7%) were ratified. Fifteen attributes had the support of 100% of the working group.
  
  
  CONCLUSIONS
  There was a high degree of agreement concerning the selected attributes. Fifteen of them had the support of 100% of the working group and could be considered the definition of the ideal bDMARD in the first lines of RA treatment.
authors.affiliation: Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, Madrid, España. Electronic address: santiago.munoz@salud.madrid.org.
authors.forename: Santiago
authors.initials: S
authors.lastname: Muñoz-Fernández
authors.affiliation: Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
authors.forename: María Sagrario
authors.initials: MS
authors.lastname: Bustabad Reyes
authors.affiliation: Hospital Universitario Araba, Vitoria, Álava, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo Alén
authors.affiliation: Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Castaño Sánchez
authors.affiliation: Hospital de Mérida , Mérida, Badajoz, España.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Chamizo Carmona
authors.affiliation: Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España.
authors.forename: Héctor
authors.initials: H
authors.lastname: Corominas
authors.affiliation: Hospital Arnau de Vilanova, Valencia, España.
authors.forename: Nagore
authors.initials: N
authors.lastname: Fernández-Llanio Comella
authors.affiliation: Hospital Clínico de Salamanca, Salamanca, España.
authors.forename: María Cristina
authors.initials: MC
authors.lastname: Hidalgo Calleja
authors.affiliation: Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España.
authors.forename: José Javier
authors.initials: JJ
authors.lastname: Pérez Venegas
authors.affiliation: Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rodríguez Heredia
authors.affiliation: Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España.
authors.forename: Susana María
authors.initials: SM
authors.lastname: Romero Yuste
authors.affiliation: Hospital Clínic i Provincial, Barcelona, España.
authors.forename: Virginia
authors.initials: V
authors.lastname: Ruiz-Esquide Torino
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D000066491:Clinical Decision-Making; D006801:Humans; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors
keywords: Artritis; Biológico; Características; Characteristic, Arthritis, Biologic, Disease-modifying antirheumatic drug, Selection.; Fármaco antirreumático modificador de la enfermedad; Selección