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Review
. 2020 Feb;23(2):140-152.
doi: 10.1111/1756-185X.13762. Epub 2019 Dec 19.

Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted-synthetic therapy for the treatment of rheumatoid arthritis

Joanna Wai Yee Leong  1 , Peter P Cheung  2   3 , Sajeewani Dissanayake  2 , Warren Weng Seng Fong  4 , Keng Hong Leong  5 , Ying Ying Leung  4 , Anita Yee Nah Lim  2   3 , Nai Lee Lui  6 , Mona Manghani  7 , Amelia Santosa  2   3 , Melonie Kannamma Sriranganathan  1 , Ernest Suresh  8 , Teck Choon Tan  9 , Gim Gee Teng  2   3 , Manjari Lahiri  2   3
Affiliations
Review

Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted-synthetic therapy for the treatment of rheumatoid arthritis

Joanna Wai Yee Leong et al. Int J Rheum Dis. 2020 Feb.

Abstract

Introduction: Approximately 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional-synthetic disease-modifying anti-rheumatic drugs (csDMARDs). However, widespread use of biologic DMARDs (bDMARDs) and targeted-synthetic (tsDMARDs) is limited by cost. We formulated updated recommendations for eligibility criteria for government-assisted funding of bDMARDs/tsDMARDs for RA patients in Singapore.

Materials and methods: Published guidelines regarding use of bDMARD and tsDMARDs were reviewed. We excluded those without a systematic literature review, formal consensus process or evidence grading. Separately, unpublished national reimbursement guidelines were included.

Results: Eleven recommendations regarding choice of disease activity measure, initiation, order of selection and continuation of bDMARD/tsDMARDs were formulated. A bDMARD/tsDMARD is indicated if a patient has: (a) at least moderately active RA with a Disease Activity Score in 28 joints/erythrocyte sedimentation rate (DAS28-ESR) score of ≥3.2; (b) failed ≥2 csDMARD strategies, 1 of which must be a combination; (c) received an adequate dose regimen of ≥3 months for each strategy. For the first-line bDMARD/tsDMARD, either tumor necrosis factor inhibitors (TNFi), non-TNFi (abatacept, tocilizumab, rituximab), or tsDMARDs, may be considered. If a first-line TNFi fails, options include another TNFi, non-TNFi biologic or tsDMARDs. If a first-line non-TNFi biologic or tsDMARD fails, options include TNFi or another non-TNF biologic or tsDMARD. For continued bDMARD/tsDMARD subsidization, a patient must have a documented DAS28-ESR every 3 months and at least a moderate European League Against Rheumatism response by 6 months.

Conclusion: These recommendations are useful for guiding funding decisions, making bDMARD/tsDMARDs usage accessible and equitable in RA patients who fail csDMARDs.

Keywords: biologic; consensus; reimbursement; rheumatoid arthritis; subsidy; targeted-synthetic.

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