Is there a role for TNFα antagonists in the treatment of SSc?: EUSTAR expert consensus development using the Delphi technique

Joerg H W Distler; Suzana Jordan; Paolo Airo; Juan Jose Alegre-Sancho; Yannick Allanore; Alexandra Balbir Gurman; Roberto Caporali; Paola Caramaschi; Patricia E Carreira; Carlo Chizzolini; Maurizio Cutolo; Mehmet Tuncay Duruöz; Dominique Farge-Bancel; Roger Hesselstrand; Florenzo Iannone; Filip De Keyser; Eugene J Kucharz; David Launay; Paloma García de la Peña Lefebvre; Olga Lukacova; Bianca Marasini; Duska Martinovic; João Francisco Marques Neto; Mislav Radic; Simona Rednic; Gabriela Riemekasten; Josef Rovensky; Matthias F Seidel; Soner Senel; Vanessa Smith; Cord Sunderkötter; Evelien Ton; Jacob M van Laar; Marco Matucci-Cerinic; Ulf Müller Ladner; Oliver Distler

Is there a role for TNFα antagonists in the treatment of SSc? EUSTAR expert consensus development using the Delphi technique

Joerg H W Distler, Suzana Jordan, Paolo Airo, Juan Jose Alegre-Sancho, Yannick Allanore, Alexandra Balbir Gurman, Roberto Caporali, Paola Caramaschi, Patricia E Carreira, Carlo Chizzolini, Maurizio Cutolo, Mehmet Tuncay Duruöz, Dominique Farge-Bancel, Roger Hesselstrand, Florenzo Iannone, Filip De Keyser, Eugene J Kucharz, David Launay, Paloma García de la Peña Lefebvre, Olga LukacovaBianca Marasini, Duska Martinovic, João Francisco Marques Neto, Mislav Radic, Simona Rednic, Gabriela Riemekasten, Josef Rovensky, Matthias F Seidel, Soner Senel, Vanessa Smith, Cord Sunderkötter, Evelien Ton, Jacob M van Laar, Marco Matucci-Cerinic, Ulf Müller Ladner, Oliver Distler

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists.

METHODS: An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc.

RESULTS: Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-α inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNF-α antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-α antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-α antagonists for arthritis associated with SSc.

CONCLUSIONS: Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication in SSc, although controlled clinical trials with TNF-α antagonists are needed before general recommendations can be given.

Original language	English
Pages (from-to)	S40-S45
Number of pages	6
Journal	Clinical and Experimental Rheumatology
Volume	29
Issue number	2 Suppl 65
Publication status	Published - 4 Aug 2011

Keywords

Anti-Inflammatory Agents
Arthritis
Consensus
Delphi Technique
Disease Progression
Fibrosis
Humans
Immunologic Factors
Inflammation
Off-Label Use
Scleroderma, Systemic
Treatment Outcome
Tumor Necrosis Factor-alpha
Journal Article
Research Support, Non-U.S. Gov't

Cite this

Distler, J. H. W., Jordan, S., Airo, P., Alegre-Sancho, J. J., Allanore, Y., Balbir Gurman, A., Caporali, R., Caramaschi, P., Carreira, P. E., Chizzolini, C., Cutolo, M., Tuncay Duruöz, M., Farge-Bancel, D., Hesselstrand, R., Iannone, F., De Keyser, F., Kucharz, E. J., Launay, D., García de la Peña Lefebvre, P., ... Distler, O. (2011). Is there a role for TNFα antagonists in the treatment of SSc? EUSTAR expert consensus development using the Delphi technique. Clinical and Experimental Rheumatology, 29(2 Suppl 65), S40-S45.

@article{8b9043815e9e4294b913aab75d40b530,

title = "Is there a role for TNFα antagonists in the treatment of SSc?: EUSTAR expert consensus development using the Delphi technique",

abstract = "OBJECTIVES: To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists.METHODS: An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc.RESULTS: Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-α inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNF-α antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-α antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-α antagonists for arthritis associated with SSc.CONCLUSIONS: Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication in SSc, although controlled clinical trials with TNF-α antagonists are needed before general recommendations can be given.",

keywords = "Anti-Inflammatory Agents, Arthritis, Consensus, Delphi Technique, Disease Progression, Fibrosis, Humans, Immunologic Factors, Inflammation, Off-Label Use, Scleroderma, Systemic, Treatment Outcome, Tumor Necrosis Factor-alpha, Journal Article, Research Support, Non-U.S. Gov't",

author = "Distler, {Joerg H W} and Suzana Jordan and Paolo Airo and Alegre-Sancho, {Juan Jose} and Yannick Allanore and {Balbir Gurman}, Alexandra and Roberto Caporali and Paola Caramaschi and Carreira, {Patricia E} and Carlo Chizzolini and Maurizio Cutolo and {Tuncay Duru{\"o}z}, Mehmet and Dominique Farge-Bancel and Roger Hesselstrand and Florenzo Iannone and {De Keyser}, Filip and Kucharz, {Eugene J} and David Launay and {Garc{\'i}a de la Pe{\~n}a Lefebvre}, Paloma and Olga Lukacova and Bianca Marasini and Duska Martinovic and {Marques Neto}, {Jo{\~a}o Francisco} and Mislav Radic and Simona Rednic and Gabriela Riemekasten and Josef Rovensky and Seidel, {Matthias F} and Soner Senel and Vanessa Smith and Cord Sunderk{\"o}tter and Evelien Ton and {van Laar}, {Jacob M} and Marco Matucci-Cerinic and {M{\"u}ller Ladner}, Ulf and Oliver Distler",

year = "2011",

month = aug,

day = "4",

language = "English",

volume = "29",

pages = "S40--S45",

journal = "Clinical and Experimental Rheumatology",

issn = "0392-856X",

publisher = "Clinical and Experimental Rheumatology S.A.S.",

number = "2 Suppl 65",

}

Distler, JHW, Jordan, S, Airo, P, Alegre-Sancho, JJ, Allanore, Y, Balbir Gurman, A, Caporali, R, Caramaschi, P, Carreira, PE, Chizzolini, C, Cutolo, M, Tuncay Duruöz, M, Farge-Bancel, D, Hesselstrand, R, Iannone, F, De Keyser, F, Kucharz, EJ, Launay, D, García de la Peña Lefebvre, P, Lukacova, O, Marasini, B, Martinovic, D, Marques Neto, JF, Radic, M, Rednic, S, Riemekasten, G, Rovensky, J, Seidel, MF, Senel, S, Smith, V, Sunderkötter, C, Ton, E, van Laar, JM, Matucci-Cerinic, M, Müller Ladner, U & Distler, O 2011, 'Is there a role for TNFα antagonists in the treatment of SSc? EUSTAR expert consensus development using the Delphi technique', Clinical and Experimental Rheumatology, vol. 29, no. 2 Suppl 65, pp. S40-S45.

TY - JOUR

T1 - Is there a role for TNFα antagonists in the treatment of SSc?

T2 - EUSTAR expert consensus development using the Delphi technique

AU - Distler, Joerg H W

AU - Jordan, Suzana

AU - Airo, Paolo

AU - Alegre-Sancho, Juan Jose

AU - Allanore, Yannick

AU - Balbir Gurman, Alexandra

AU - Caporali, Roberto

AU - Caramaschi, Paola

AU - Carreira, Patricia E

AU - Chizzolini, Carlo

AU - Cutolo, Maurizio

AU - Tuncay Duruöz, Mehmet

AU - Farge-Bancel, Dominique

AU - Hesselstrand, Roger

AU - Iannone, Florenzo

AU - De Keyser, Filip

AU - Kucharz, Eugene J

AU - Launay, David

AU - García de la Peña Lefebvre, Paloma

AU - Lukacova, Olga

AU - Marasini, Bianca

AU - Martinovic, Duska

AU - Marques Neto, João Francisco

AU - Radic, Mislav

AU - Rednic, Simona

AU - Riemekasten, Gabriela

AU - Rovensky, Josef

AU - Seidel, Matthias F

AU - Senel, Soner

AU - Smith, Vanessa

AU - Sunderkötter, Cord

AU - Ton, Evelien

AU - van Laar, Jacob M

AU - Matucci-Cerinic, Marco

AU - Müller Ladner, Ulf

AU - Distler, Oliver

PY - 2011/8/4

Y1 - 2011/8/4

N2 - OBJECTIVES: To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists.METHODS: An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc.RESULTS: Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-α inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNF-α antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-α antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-α antagonists for arthritis associated with SSc.CONCLUSIONS: Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication in SSc, although controlled clinical trials with TNF-α antagonists are needed before general recommendations can be given.

AB - OBJECTIVES: To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists.METHODS: An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc.RESULTS: Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-α inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNF-α antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-α antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-α antagonists for arthritis associated with SSc.CONCLUSIONS: Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication in SSc, although controlled clinical trials with TNF-α antagonists are needed before general recommendations can be given.

KW - Anti-Inflammatory Agents

KW - Arthritis

KW - Consensus

KW - Delphi Technique

KW - Disease Progression

KW - Fibrosis

KW - Humans

KW - Immunologic Factors

KW - Inflammation

KW - Off-Label Use

KW - Scleroderma, Systemic

KW - Treatment Outcome

KW - Tumor Necrosis Factor-alpha

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

M3 - Article

C2 - 21586217

SN - 0392-856X

VL - 29

SP - S40-S45

JO - Clinical and Experimental Rheumatology

JF - Clinical and Experimental Rheumatology

IS - 2 Suppl 65

ER -

Is there a role for TNFα antagonists in the treatment of SSc? EUSTAR expert consensus development using the Delphi technique

Abstract

Keywords

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