Background Pharmacological management of rheumatoid arthritis patients is based on the use of complex drugs such as disease modifying anti-rheumatic drugs (DMARDs) and innovative biological agents. Safe use of these drugs involves close and effective monitoring resulting in efficient risk management and improved quality of care provided to patients.
Objectives The objectives of the study were to compile and evaluate algorithms intended to illustrate a stepwise approach in the monitoring required when prescribing and administering DMARDs and biological agents to rheumatoid arthritis patients.
Methods A literature review was carried out to assess the current international guidelines on monitoring of DMARDs and biological agents. Interviews were carried out with two consultant rheumatologists as to the practice trends of monitoring. Draft algorithms were compiled and submitted for expert panel review. The expert panel consisting of ten members assessed applicability of the algorithms to the practical scenario, presentation, robustness and validity of the data provided. The final RhMonitoring Algorithms were compiled taking into account feedback proposed by the expert panel.
Results Algorithms for the 5 most commonly used DMARDs (methotrexate, hydroxychloroquine, sulphasalazine, leflunomide, sodium aurothiomalate) and the locally currently available biological agents, etanercept, adalimumab, infliximab and rituximab were compiled. The expert panel consisted of a consultant rheumatologist, a rheumatology resident trainee, two research and academic pharmacists, a risk management pharmacist, a quality assurance pharmacist, a rheumatology nurse specialist, two medical doctors and a staff nurse. Response rate was 80%. All agreed that the algorithms are easy to follow, well laid out and practical. Three members commented that cautions and contraindications should be included alongside each respective algorithm to highlight these issues.
Conclusions The developed RhMonitoring Algorithms present in a simplified manner the complex information on the monitoring frequency of DMARDs and biological agents. They also serve to standardise the monitoring plans required with these drugs in order across an interdisciplinary team so as to increase the level of patient care and service development.
Acknowledgements The research group would like to acknowledge the members of the expert panel.
Disclosure of Interest None declared