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APLAR RA Treatment Recommendations Update 2023

Recommendation statement consensus survey


This survey is to assess the level of agreement among the working group with the proposed new or amended recommendations. These new recommendations were drafted based on current literature and discussions among the group at the first working group meeting.

The survey will rate your agreement with each recommendation on a 5-point Likert scale (ie, 5, strongly agree; 4, agree; 3, neither agree nor disagree; 2, disagree; 1 strongly disagree); agreement by 75% of total voting group members is defined as the threshold for acceptance of a statement.

Please consult the report from the Beijing meeting in September for further details and evidence assessment.
Question 1. (amendment of statement 2018 6): Vaccination should be considered prior to initiating conventional or targeted therapy, depending on the patient’s circumstances.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 2. (amendment of statement 2018 6): If vaccination is required during treatment, a temporary discontinuation of targeted therapy for 1 or 2 weeks after vaccination should be considered.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 3. (amendment of statement 2018 6): Pneumococcal and influenza vaccines are recommended. Vaccines for HBV, HPV, COVID-19 and meningococcal infections are conditionally recommended.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 4. (amendment of statement 2018 6): During targeted therapy, live-attenuated virus vaccines are contraindicated.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 5. (new recommendation): Musculoskeletal ultrasound may be used in the initial diagnosis of RA where joint count is inconclusive.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 6. (new recommendation): Methotrexate should be initiated at a dose of up to 12.5 mg/week, and then rapidly escalated by 5 mg every 4 weeks to the maximum tolerated and effective dose.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 7. (new recommendation): In patients who have inadequate response to methotrexate monotherapy, adding another csDMARD should be considered.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 8. (new recommendation): At confirmed remission, discontinuation of DMARD therapy is not recommended. Instead, gradually minimising dose (until the lowest effective dose is reached) is recommended.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 9. (amendment of statement 2015 26): A bDMARD should be prescribed in patients who have inadequate response or intolerance to cDMARDs.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 10. (amendment of statement 2015 27): Early initiation of bDMARDs can be considered in patients who have active disease with poor prognostic factors.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 11. (amendment of statement 2015 31): bDMARDs are most effective when combined with a csDMARD (especially methotrexate). In patients who have intolerance to csDMARDs, an IL-6 pathway inhibitor or a tsDMARD may be an option for monotherapy.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 12. (amendment of statement 2015 32): In patients with RA who are candidates for bDMARD therapy, therapeutic options include TNF antagonists, abatacept, rituximab and IL-6 inhibitors (originator or biosimilar).

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 13. (amendment of statement 2015 33): Patients who fail to achieve remission or low disease activity after 6 months of bDMARD therapy are recommended to switch to another bDMARD or tsDMARD.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 14. (amendment of statement 2015 34): Tapering of bDMARDs and tsDMARDs should be considered in patients who have achieved sustained remission (>12 months). For bDMARDs, dosage should be decreased to the longest effective spacing between administrations. For tsDMARDs, dosage should be tapered to the lowest effective dose, especially if the patient is receiving concomitant csDMARDs.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 15. (amendment of statement 2015 35): Screening for TB is recommended prior to starting bDMARD therapy.

All patients with latent TB infection should receive prophylactic anti-TB therapy. Patients with active TB infection need to be adequately treated before bDMARD treatment. For RA patients with a history of TB or latent TB or who are at high risk of TB despite negative screening, bDMARDs other than monoclonal antibody TNFi are preferred.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 16. (combination of statements 2015 36 and 11): Patients should be screened for HBV and HCV infections prior to the commencement of bDMARDs. bDMARDs should be avoided in patients with active or untreated chronic HBV infection and active HCV infection. For RA patients at increased risk of HBV reactivation, targeted therapies other than rituximab are preferred.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 17. (new statement): Targeted therapies (bDMARDs and tsDMARDs) can be prescribed to patients who have disease activity despite adequate treatment with csDMARDs.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 18. (new statement): IL-6 inhibitors and JAK inhibitors may have advantages over other targeted therapies when administered without concomitant csDMARDs.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 19. (amended statement 2018 40): Switching to a tsDMARD after a bDMARD has failed may be considered.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 20. (new statement): Surveillance for infection, malignancy and cardiovascular disease may be needed in high-risk populations.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 21. (amended statement 2015 3): Oral glucocorticoids can be considered for the control of active RA as a bridging therapy with csDMARDs at less than 10 mg/day for no more than 3 months.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Question 22. (amended statement 2018 6): For patients with established RA in whom disease cannot otherwise be controlled, TNFi may be continued throughout pregnancy.

Please indicate your level of agreement with the above statement: *
Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional comments:
Thank you for completing this survey. Results will be presented and discussed at the upcoming working group meeting on November 20ᵗʰ.
EM-CHN-ino-0008