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.

• Authors: 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
• Journal: Clinical and experimental rheumatology (Clin Exp Rheumatol) 2011 Mar-Apr Vol. 29 Issue 2 Suppl 65 Pg. S40-5 ISSN: 0392-856X [Print] Italy
• PMID: 21586217 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents
• Immunologic Factors
• Tumor Necrosis Factor-alpha

Topics

• Anti-Inflammatory Agents (administration & dosage, adverse effects)
• Arthritis (drug therapy, etiology, immunology, pathology)
• Consensus
• Delphi Technique
• Disease Progression
• Fibrosis
• Humans
• Immunologic Factors (administration & dosage, adverse effects)
• Inflammation
• Off-Label Use
• Scleroderma, Systemic (complications, drug therapy, pathology)
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)