New resources to support down-titration of b/tsDMARDs

A new set of resources to help consumers, specialists and other health professionals make safe and wise decisions about reducing the dose of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) is now available from the Targeted Therapies Alliance.

Part of a wider three year program under the Australian Government’s Value in Prescribing program to ensure the best possible health and economic outcomes from investment in these therapies, the new resources will support the implementation of new living guidelines developed by the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network. These living guidelines, which are currently out for public consultation prior to NHMRC endorsement, recommend that prescribers may consider down-titration of b/tsDMARDs for people with rheumatoid arthritis or axial spondyloarthritis who are in remission or have low disease activity.

NPS MedicineWise CEO Adjunct Associate Professor Steve Morris says the new down-titration algorithm, patient decision aid, and patient fact sheet will support clinicians to implement the evidence about safe down-titration of b/tsDMARDs in their practice, and will help them to work safely with people with arthritis to reduce the dose of their medicine.

A new series of short videos available on the Targeted Therapies Alliance website provides context around what the living guidelines include and what resources are now available to help implement the new recommendations. Complementing this, a webinar will be hosted by the Australian Rheumatology Association on Wednesday 4 November 2020.

President of the Australian Rheumatology Association Professor Catherine Hill says the resources for rheumatologists, pharmacists and consumers, underpinned by the evidence synthesis and development of living guidelines, will support optimal care of people taking these medicines, and the webinar on 4 November will introduce this information for rheumatologists and other health professionals.

ANZMUSC Chair Professor Rachelle Buchbinder says the national living guidelines for inflammatory arthritis are a world first.

“The guideline panel included wide representation of rheumatologists, other health professionals and people with arthritis. The fact that they are ‘living’ means that we will be able to update the recommendations as needed in response to new information whenever it becomes available. Provision of evidence summaries and practical considerations should provide rheumatologists with the confidence to implement them. Additional resources that include patient decision aids and treatment algorithms will also help to increase the uptake of the guidelines into routine care for the benefit of our patients,” said Prof Buchbinder.

The new down-titration resources complement PBS Practice Review reports sent in October to around 450 rheumatologists and relevant immunologists across Australia containing individualised prescribing data. Intended for health professional personal reflection, these reports encourage optimisation of first line treatment and aim to help guide treatment decisions around choice of biologics and minimisation of glucocorticoid and opioid use.

About the Targeted Therapies Alliance

Funded by the Australian Government Department of Health through the Value in Prescribing – Biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) Program Grant, and led by NPS MedicineWise, members of the Targeted Therapies Alliance include:

• Arthritis Australia
• Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network
• Australian Rheumatology Association
• Cochrane Musculoskeletal
• Council of Australian Therapeutic Advisory Groups
• NPS MedicineWise
• Pharmaceutical Society of Australia
• Quality Use of Medicines and Pharmacy Research Centre (University of South Australia)
• Society of Hospital Pharmacists of Australia

The Alliance is jointly responsible for a range of evidence-based educational resources, tools and interventions to support consumers, specialist prescribers, pharmacists, nurses and governance bodies. Over the coming months, NPS MedicineWise and the organisations who make up the Alliance will publish specific information about the use of biological and other specialised medicines across a range of rheumatology, dermatology and gastroenterology conditions. This will include, for example, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, psoriasis, Crohn disease and ulcerative colitis.

For more information on the Targeted Therapies Alliance, bDMARDs and other specialised medicines, visit the program website.