Reply

I. F. Rowe, A. Filer, C.-S. Yee1, A. Pace1, K. Douglas and D. Situnayake2 on behalf of the West Midlands Rheumatology Services and Training Committee

Departments of Rheumatology, Worcestershire Royal Hospital, Worcester, 1Dudley Guest Hospital, Dudley and 2City Hospital, Birmingham, UK

Correspondence to: I. Rowe. E-mail: ian.rowe{at}worcsacute.wmids.nhs.uk

We thank Bartram et al. for the interest in our paper [1] and are pleased that this has been supplemented by further clinical audit in the West Midlands. One of the secondary aims of our study was to raise awareness of the issues surrounding the provision of resources for the administration of the anti-TNF therapies, both in financial and practical terms. It remains a useful tool for estimating the need for such resources because it is the only study of its size to estimate the requirement for biological therapies in a hospital population in the window before NICE guidance [2] made such treatments more widely accessible. The audit undertaken by Bartram et al. highlights various interesting practical problems associated with the introduction of these new therapies into daily clinical rheumatological practice. We would therefore agree with their assertion that their findings give a practical depth to our necessarily more theoretical study. The introduction of DAS scores into routine practice, as recently argued by Scott et al. [3], may be the best approach to the problem of recording response to treatment and improving clinical decision making, but any potential improvements in care would need to be offset against the cost of implementation.

Clearly, more detailed analysis of both the short- and long-term tolerance and side-effects of biological therapies in a large patient population is of paramount importance. The Spanish BIOBADASER biological registry has already been useful in illustrating vulnerability to Mycobacterium tuberculosis infection in those treated with biological therapies, with the caveat that relatively small numbers of patients had been followed beyond 1 yr at the time of publication. This study revealed a pooled withdrawal rate of only 9% at 6 months and 19% at 24 months [4], again somewhat short of the 40% suggested by NICE. Further data should be available in due course through the nationally organized British Society for Rheumatology Biologics Register in Manchester.

References

  1. Yee C-S, Filer A, Pace A, Douglas K, Situnayake D, Rowe IF. The prevalence of patients with rheumatoid arthritis in the West Midlands fulfilling the BSR criteria for anti-tumour necrosis factor therapy: an out-patient study. Rheumatology 2003;42:856–9.[Abstract/Free Full Text]
  2. National Institute for Clinical Excellence. Guidance on the use of etanercept and infliximab for the treatment of rheumatoid arthritis. Guidance no. 36. London: National Institute for Clinical Excellence, 2002. www.nice.org.uk
  3. Scott DL, Antoni C, Choy EH, Van Riel PC. Joint counts in routine practice. Rheumatology 2003;42:919–23.[Free Full Text]
  4. Gomez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD, BIOBADASER Group. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum 2003;48:2122–7.[CrossRef][ISI][Medline]
Accepted 2 September 2003





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