The development of a risk threshold to aid risk stratified approach to monitoring for haematological, hepatic and/or renal adverse drug reactions during established cs DMARD treatment for systemic autoimmune rheumatic diseases: a RAND/UCLA Appropriateness Method consensus study
Year: 2026
Type: article
Abstract: OBJECTIVE: To explore how appropriate different intervals between monitoring blood tests are considered in relation to the risk of clinically significant adverse drug reactions in adults prescribed conventional synthetic DMARDs (csDMARDs) for ≥1 year for systemic autoimmune rheumatic diseases (SARD). METHODS: A RAND/UCLA Appropriateness Method consensus study was undertaken. Members of the BSR csDMARD guideline working group who manage adults with SARD participated. Experts rated the extent to which intervals between blood tests were appropriate using Likert-type scales with responses from 1 (totally inappropriate) to 9 (totally appropriate) for nine scenarios with 5-year predicted risk of discontinuing treatment due to abnormal monitoring blood tests from 5% to 25%. Median score and the number that voted 1-3 (inappropriate), 4-6 (unsure) and 7-9 (appropriate) were calculated for every interval in each scenario. Scenarios for which agreement could not be reached in the first round were recirculated, enclosing individual round 1 response and the panel median score. Consensus that an interval was appropriate for a scenario was reached where the median panel score was ≥7 and up to six experts rated <7. The results were discussed with patient and public involvement members and experts. RESULTS: Twenty-one of the 27 invitees participated. They comprised 11 consultants/GPs, five specialist nurses, three pharmacists and two rheumatology specialty trainees. Consensus was reached for all scenarios. Six- and three-monthly blood tests were agreed as appropriate when the predicted risk was ≤10% and >10% over 5 years, respectively. CONCLUSION: A threshold to aid risk-stratified monitoring during established csDMARD treatment was agreed for adults with SARD.
Source: Lara D. Veeken
Authors: Joanne Ablewhite, Georgina Nakafero, Abdullah Almayahi, Katie Bechman, Alison Ahmed, Alan Davidson, Hope De Vere, Emmandeep Dhillon, Amy Foulkes, Nicola Gullick, Rebecca Heaton, Samantha Hider, Stuart Kyle, Kataryzna Nowak, Emily Rose-Parfitt, Sarah Ryan, Su Yin Tan, Natasha Wood, Genevieve Zebate, Kate Parsons, Julia Holmes, Helen Twohigg, John A Reynolds, Louise Mercer, James Galloway, Abhishek Abhishek
Institutions: University of Nottingham, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, King's College London, Tameside Hospital, Tameside and Glossop Integrated Care NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, Boehringer Ingelheim (United Kingdom), New Cross Hospital, The Royal Wolverhampton NHS Trust, Salford Royal NHS Foundation Trust, University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, University of Warwick, Stepping Hill Hospital, Stockport NHS Foundation Trust, Keele University, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Belfast Health and Social Care Trust, North Bristol NHS Trust, Midlands Partnership NHS Foundation Trust, Northern Devon Healthcare NHS Trust, NHS Lothian, Western General Hospital, University of Birmingham
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,597
OpenAlex ID: W7127167312