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

Clinical and Experimental Rheumatology

Bianca Marasini¹  Juan Jose Alegre-Sancho¹  Maurizio Cutolo¹  Marco Matucci-Cerinic¹  Olga Lukacova¹  David Launay¹  Dominique Farge-Bancel¹  Evelien Ton¹  Simona Rednic¹  Vanessa Smith¹  Roger Hesselstrand¹  Patricia E Carreira¹  Matthias F. Seidel¹  Gabriela Riemekasten¹  Duska Martinovic¹  Paola Caramaschi¹  Suzana Jordan¹  Paloma García de la Peña Lefebvre¹  Carlo Chizzolini¹  Cord Sunderkötter¹  Eugene J. Kucharz¹  Florenzo Iannone¹  Josef Rovensky¹  Roberto Caporali¹  Jacob M. van Laar¹  Mislav Radic¹  Yannick Allanore¹  Paolo Airo¹  Filip De Keyser¹  Mehmet Tuncay Duruöz¹  Joerg H.W. Distler¹  Oliver Distler¹  Soner Senel¹  Ulf Müller Ladner¹  João Francisco Marques Neto¹  Alexandra Balbir Gurman¹ 

关键词: Systemic sclerosis;    TNFα;    fibrosis;   

DOI  :  

学科分类：医学（综合）

来源: Pacini Editore SpA

【 摘 要 】

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.

【 授权许可】

Unknown