First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis
Keywords:
rheumatoid arthritis, Cuban consensus, biological therapy in CubaAbstract
Introduction: The development of recommendations aimed at the treatment of rheumatoid arthritis (RA) in the context of the Cuban reality, may be one of the ways to achieve better control of this disease.
Objective: preparation of recommendations aimed at conventional and biological therapy for RA in Cuba.
Methods: 18 specialists from 8 Cuban provinces, experts in the management of RA, were summoned. Experts: years of dedication, conferences on this topic, publications. A first meeting was held in March / 2016, in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. The following tasks were developed: review of the bibliography on conventional and biological therapy previously recruited by the participating rheumatologists, 2 teams were structured; one of them would address everything related to conventional therapy in RA (HRCT) and the other biological therapy in RA (TBAR). 3 questionnaires related to: use of corticosteroids, HRCT and TBAR were prepared, answered by the participants via email. In a second meeting, held in October 2016, in Havana, the analysis of each of the responses provided was carried out. Questions whose answer had 90% or more votes were considered as recommendation.
Results: 9 recommendations and 1 algorithm were established. The recommendations obtained are the following: methotrexate is the drug of choice in the treatment of RA once the diagnosis has been made, - the use of another DMARDc (AZA, SSZ, antimalarials and leflunomide) in patients with a diagnosis of active RA in patients with that MTX was contraindicated or there was a failure in the response to it, - consider the administration of low doses of prednisone or equivalent (<7.5 mg / day) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time -Perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and DMARDb, - Those patients where remission or, at least, a DAS was obtained 28 below 3.2, consider withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers, - TCZ combined with MTX or in monoterapia should be indicated if the MTX fails, alone or in combination.
The questionnaires were answered by 95% or more of the participants.
Conclusions: Aspects related to conventional therapy with MTX, AZA, SSZ, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy was analyzed. The management of the CG was analyzed. The beginning of treatment with TCZ, the only biological available in Cuba for RA, will be done when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patients.
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References
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