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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX" /><meta name="author" content="National Guideline Centre (UK)" /><meta name="citation_title" content="Target for monitoring" /><meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)" /><meta name="citation_date" content="2018/07" /><meta name="citation_author" content="National Guideline Centre (UK)" /><meta name="citation_pmid" content="35129925" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK577120/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Target for monitoring" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)" /><meta name="DC.Contributor" content="National Guideline Centre (UK)" /><meta name="DC.Date" content="2018/07" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK577120/" /><meta name="og:title" content="Target for monitoring" /><meta name="og:type" content="book" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK577120/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng100er4-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/niceng100er4/toc/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK577120/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng100er4-lrg.png" alt="Cover of Target for monitoring" /></a><div class="icnblk_cntnt"><h1 id="_NBK577120_"><span itemprop="name">Target for monitoring</span></h1><div class="subtitle">Rheumatoid arthritis in adults: diagnosis and management</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 100</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2018 Jul</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3003-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="chd1"><h2 id="_chd1_">1. Target for monitoring</h2><div id="chd1.s1"><h3>1.1. Review question: In adults with rheumatoid arthritis, what is the
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best target to use when monitoring disease activity (remission or low
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disease activity)?</h3></div><div id="chd1.s2"><h3>1.2. Introduction</h3><p>Current consensus amongst the rheumatology community is that a
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treat-to-target strategy should be used when treating people with
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rheumatoid arthritis (RA) with DMARDs. A treat-to-target strategy is a
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strategy that defines a treatment target (such as remission or low
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disease activity) and applies tight control (for example, monthly visits
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and respective treatment adjustment) to reach this target. The treatment
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strategy often follows a protocol for treatment adaptions depending on
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the disease activity level and degree of response to treatment.</p><p>The 2009 NICE guideline: Rheumatoid arthritis in adults: management<a class="bk_pop" href="#ptd.ref9"><sup>9</sup></a> suggested a
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treat-to-target approach in the recommendations that said to measure
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inflammatory markers and disease activity monthly “until
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treatment has controlled the disease to a level previously agreed with
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the person with RA”. However, the committee agreed that the
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evidence for a treat-to-target strategy should be reviewed, to make this
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recommendation clearer and more direct if supported by the evidence.</p><p>The committee also agreed that greater clarity was needed on how
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frequently people with rheumatoid arthritis should be monitored, as
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there was currently variation in practice and some uncertainty about how
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frequent monitoring should be in different groups of people with
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rheumatoid arthritis with varying degrees of disease activity. However,
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the frequency of monitoring review excluded an update of the annual
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review recommended in the previous guideline, as it is an essential and
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well-established practice and therefore was not included within the
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scope of this update.</p><p>Three interrelated evidence reviews were conducted to answer the
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following key questions in this area: <ol id="l73"><li id="lt217" class="half_rhythm"><div>Is treat-to-target more effective than usual care?</div></li><li id="lt218" class="half_rhythm"><div>If so, should the treatment target be low disease activity or
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remission?</div></li><li id="lt219" class="half_rhythm"><div>How often should people be monitored, outside of the annual
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review?</div></li></ol></p></div><div id="chd1.s3"><h3>1.3. PICO table</h3><p>For full details, see the review protocol in <a href="#ptd.appa">appendix A</a>.</p></div><div id="chd1.s4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process
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described in Developing NICE guidelines: the manual.<a class="bk_pop" href="#ptd.ref1"><sup>1</sup></a> Methods specific
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to this review question are described in the review protocol in <a href="#ptd.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014
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conflicts of interest policy.</p></div><div id="chd1.s5"><h3>1.5. Clinical evidence</h3><div id="chd1.s5.1"><h4>1.5.1. Included studies</h4><p>A search was conducted for randomised controlled trials and
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systematic reviews of randomised controlled trials comparing
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remission with low disease activity as targets in monitoring RA.</p><p>No relevant clinical studies were identified.</p><p>See also the study selection flow chart in <a href="#ptd.appc">appendix C</a>.</p></div><div id="chd1.s5.2"><h4>1.5.2. Excluded studies</h4><p>See the excluded studies list in <a href="#ptd.appi">appendix I</a>.</p></div><div id="chd1.s5.3"><h4>1.5.3. Summary of clinical studies included in the evidence
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review</h4><p>No relevant clinical studies were identified.</p></div><div id="chd1.s5.4"><h4>1.5.4. Quality assessment of clinical studies included in the evidence
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review</h4><p>No relevant clinical studies were identified.</p></div></div><div id="chd1.s6"><h3>1.6. Economic evidence</h3><div id="chd1.s6.1"><h4>1.6.1. Included studies</h4><p>No relevant health economic studies were identified.</p></div><div id="chd1.s6.2"><h4>1.6.2. Excluded studies</h4><p>No health economic studies that were relevant to this question were
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excluded due to assessment of limited applicability or
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methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#ptd.appg">appendix G</a>.</p></div><div id="chd1.s6.3"><h4>1.6.3. Unit costs</h4></div></div><div id="chd1.s7"><h3>1.7. Resource costs</h3><p>The recommendations made in this review are not expected to have a
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substantial impact on resources.</p></div><div id="chd1.s8"><h3>1.8. Evidence statements</h3><div id="chd1.s8.1"><h4>1.8.1. Clinical evidence statements</h4><p>No relevant clinical studies were identified.</p></div><div id="chd1.s8.2"><h4>1.8.2. Health economic evidence statements</h4><ul id="l78"><li id="lt233" class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div><div id="chd1.s9"><h3>1.9. The committee’s discussion of the evidence</h3><div id="chd1.s9.1"><h4>1.9.1. Interpreting the evidence</h4><div id="chd1.s9.1.1"><h5>1.9.1.1. The outcomes that matter most</h5><p>The critical outcomes were agreed to be the Disease Activity
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Score (DAS), quality of life and function for all 3 reviews.</p><p>Pain, radiographic progression, fatigue and the number of people
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who withdrew from the trial were agreed to be important outcomes
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for all 3 reviews. The treat-to-target review and the frequency
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of monitoring review also specified the number of people
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achieving remission and low disease activity, using DAS
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thresholds, as important outcomes. The committee agreed that
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data reported in this format are not as informative as
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continuous DAS data but still give an indication of symptom
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relief and disease activity improvement. Disease activity data
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in this dichotomous format were not considered informative for
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the review of whether low disease activity or remission was the
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better target given the question posed by the review.</p><p>In the treat-to-target review, no data were available for the
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outcome of fatigue. For the frequency of monitoring review, no
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data were available for any of the disease activity outcomes,
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quality of life or fatigue.</p><p>No studies were identified for the review of remission compared
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with low disease activity as a treatment target.</p></div><div id="chd1.s9.1.2"><h5>1.9.1.2. The quality of the evidence</h5><div id="chd1.s9.1.2.1"><h5>Treat-to-target versus usual care</h5><p>Five studies were included in the review of treat-to-target
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versus usual care. The quality of the evidence was varied,
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ranging from moderate to very low quality, with the majority
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of the outcomes graded either low or very low quality. A
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lack of blinding was a source of risk of bias in all of the
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included studies. Some studies also poorly reported aspects
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of their design such as how they randomised participants,
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concealed allocation, and dealt with missing data, which
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affected the quality rating. For those outcomes where the
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data was reported by only 1 or 2 trials, the confidence
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intervals tended to be wide which meant there was some
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uncertainty about whether the treat-to-target strategy was
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more effective than usual care.</p><p>Importantly, there was substantial inconsistency in the
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magnitude of the benefit of treat-to-target across the
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studies and between different treat-to-target arms within
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studies, which also affected the quality of the evidence for
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most outcomes (DAS, HAQ, remission, low disease activity,
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pain, and study discontinuation). It was not possible to
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conduct formal subgroup analysis to see if this explained
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the heterogeneity, as there were too few studies in each
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subgroup category. However, the committee discussed the
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possible reasons for these differing results. The committee
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noted the great variation in the design of the studies,
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particularly around the disease duration of participants
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(which ranged from less than 1 year in 1 study, to a median
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of 6-7 years in another study), the nature of the target
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used in the intervention arm (whether a DAS-based target was
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used), and whether or not either or both study arms used a
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protocol-driven treatment strategy (some studies did not use
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a protocol in either arm, other studies used a protocol in
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both arms and some studies compared a protocol in the
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intervention arm to usual care without a protocol).</p><p>The committee agreed that it was not possible to establish
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definitively which of these factors (if any) might explain
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the differences in the magnitude of the effect between the
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studies. However, the committee noted that while there was
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some inconsistency in the magnitude of the benefit of
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treat-to-target in improving disease activity, function and
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pain, in general the majority of evidence across outcomes
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favoured treat-to-target over usual care. The few results
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that did suggest a benefit of usual care were generally from
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the non- DAS-based target arms of 2 studies (which used
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targets of zero swollen joint count and matrix
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metalloproteinase 3 levels). The results of the DAS-based
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target arms of those studies favoured the intervention arm,
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consistent with the other study results.</p></div><div id="chd1.s9.1.2.2"><h5>Remission or low disease activity as the target</h5><p>No evidence was identified comparing the targets of remission
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or low disease activity. Recommendations were therefore
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informed by GC consensus opinion.</p></div><div id="chd1.s9.1.2.3"><h5>Frequency of monitoring</h5><p>One study was included in the review of different monitoring
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frequencies. This study compared patient-initiated rapid
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access with traditionally scheduled reviews every 3 to 6
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months. All of the evidence was assessed to be very low
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quality. Lack of blinding, along with relatively high rates
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of missing data and limited information about how this was
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dealt with in the analysis contributed to the risk of bias.
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It was also unclear what was measured at each review and
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whether the minimum requirements as specified in the review
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protocol were satisfied (assessment of the joints for
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swelling and measurement of inflammatory markers), which
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further weakened the evidence. The evidence was also
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assessed to be indirect to that specified in the protocol
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due to the variation in the frequency of reviews in the
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control group, and the population being a mix of people with
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stable and unstable disease.</p><p>No studies were found comparing any other frequencies of
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monitoring.</p><div id="chd1.s9.1.2.3.1"><h5>People at risk of poor outcomes</h5><p>People with a poor prognosis were pre-specified as a
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separate stratum in the protocols for the review of
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remission versus low disease activity as a target and
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the review of frequency of monitoring. People with a
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poor prognosis were considered to be those with one or
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more of the key prognostic factors identified in a
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separate review, which were anti-CCP positive status and
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the presence of erosions at baseline. No evidence was
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found in this subgroup of people for either
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question.</p></div></div></div><div id="chd1.s9.1.3"><h5>1.9.1.3. Benefits and harms</h5><div id="chd1.s9.1.3.1"><h5>Treat-to-target versus usual care</h5><p>The committee agreed that the evidence for the
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treat-to-target versus usual care review suggested that a
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treat-to-target approach was more effective than usual care.
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The committee acknowledged the limitations of the evidence
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base described above, but were persuaded by the consistency
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of the overall findings of a clinically important benefit in
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favour of treat-to-target across almost all of the outcomes.
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The committee acknowledged that the more frequent
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appointments usually required with treat-to-target
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management could, for some people, be difficult to combine
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with full time work, although this would depend on the
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individual. The committee were reassured by the evidence
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that not only did treat-to-target appear to be more
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clinically effective than usual care, study discontinuation
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rates tended to be lower in people receiving treat-to-target
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care, even though the frequency of monitoring in the
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treat-to-target groups was often higher and so the burden on
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people attending the appointments greater.</p><p>In further support of treat-to-target despite the differences
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in the included studies, the committee agreed that one
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included study most closely reflected the treat-to-target
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and usual care approaches used in clinical practice in
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England, whereas some of the other included studies used
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more unusual designs. This study was the only study that
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utilised more frequent monitoring and a protocol-driven
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treatment strategy in the intervention group, compared with
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less frequent visits and treatment at the discretion of
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treating doctor in the usual care group. The committee noted
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that this trial found consistent and substantial benefits of
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treat-to-target approach over usual care, which further
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reinforced their view that treat-to-target was more
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effective than usual care. In addition, the committee noted
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that many of the included studies in the separate evidence
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review of DMARD treatment, which reported positive outcomes
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for people with rheumatoid arthritis, were strategy trials
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that employed a treat-to-target approach. This provided
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further indirect evidence of the importance of
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treating-to-target to achieve good outcomes for people with
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rheumatoid arthritis.</p><p>The committee unanimously agreed that a treat-to-target
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approach to managing rheumatoid arthritis was essential to
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achieving rapid and sustained disease control and was the
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cornerstone of modern rheumatology practice. The lay members
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of the committee strongly emphasised the difference made to
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the lives of people with rheumatoid arthritis when a
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treat-to-target approach is implemented. Without a
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treat-to-target approach, people with rheumatoid arthritis
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risk being left in a moderate disease activity state, and
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these disease levels will have a significant impact on their
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daily life. If implemented appropriately, a treat-to-target
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approach should also avoid many people with rheumatoid
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arthritis having high disease activity levels warranting
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biologic DMARD treatment in the future. Although the quality
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of evidence from this review was not of high quality, the GC
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agreed that the importance of this recommendation in
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clinical practice, combined with this evidence and the
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indirect evidence from other reviews where the strategy was
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employed, all supported a strong recommendation for all
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people with rheumatoid arthritis.</p></div><div id="chd1.s9.1.3.2"><h5>Remission or low disease activity as the target</h5><p>Having agreed that a treat-to-target approach is beneficial,
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the committee discussed what the disease activity target
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should be. The committee discussed the existing
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recommendation, which did not specify a target, and agreed
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that although no evidence was identified for this review, it
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was important to specify a target to ensure that people were
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fully treated and achieved the best possible outcomes and
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understood the goal of the treatment.</p><p>In the absence of available evidence the committee discussed
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which of the 2 targets was most appropriate based on their
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experience and expertise. The committee agreed that the aim
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should always be to control disease activity to the lowest
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possible level, but that this would depend on the individual
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as in some people, treatment will not be able to achieve
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very low targets. The committee decided by consensus that
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remission (for example, DAS28 less than 2.6) is the ideal
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target for most people with rheumatoid arthritis, but for
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people who were unable to achieve this target despite a
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treat-to-target approach with appropriate escalation, low
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disease activity (for example, DAS28 less than 3.2) would be
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acceptable as this is more achievable for some people and
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agreed as a good outcome if remission can’t be
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achieved. The committee noted that remission and low disease
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activity can be measured using various composite scoring
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measures. The committee were of the view that the most
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appropriate measures were validated scoring systems that
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incorporated inflammatory markers and a swollen joint count.
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Such measures include DAS, DAS28 and SDAI.</p><p>In order to treat-to-target using a target of remission or
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low disease activity, it is essential that a disease
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activity score such as the DAS28 is measured at each visit.
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The committee acknowledged that the DAS28 can be calculated
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using either ESR or CRP (both inflammatory markers), but
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agreed that current consensus is that CRP is subject to less
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||
variability as it is a direct measure of inflammatory
|
||
protein. Hence, CRP is generally the preferred measure for
|
||
people treated with conventional DMARDs. Therefore, the
|
||
committee agreed to maintain the previous recommendation to
|
||
measure CRP and disease activity using a composite score
|
||
such as DAS28.</p></div><div id="chd1.s9.1.3.3"><h5>Frequency of monitoring</h5><p>The committee discussed how frequently people should be
|
||
monitored (a) while their disease is active as part of a
|
||
treat-to-target approach, (b) after they have achieved the
|
||
treatment target, and (c) once they have maintained disease
|
||
activity below the treatment target for a period of time and
|
||
their disease is considered well-controlled.</p><p>No evidence was identified specifically looking at how often
|
||
people with active disease should be monitored. The
|
||
committee noted that the previous guideline recommended
|
||
monthly monitoring for people with active disease. The
|
||
committee also considered the monitoring regimens in the
|
||
studies included in the treat-to-target review. These varied
|
||
between studies, however, the study considered to be the
|
||
most applicable evidence (discussed above) employed monthly
|
||
monitoring in the treat-to-target arm, compared with three
|
||
monthly in the usual care arm. The committee agreed by
|
||
consensus that monthly review of people with active disease
|
||
remained the most appropriate monitoring frequency as part
|
||
of the treat-to-target approach. Monthly monitoring in
|
||
active disease was considered necessary in order to escalate
|
||
DMARD doses, to consider the need for short-term
|
||
glucocorticoids while waiting for DMARDs to take effect, to
|
||
establish whether people were tolerating the drug and assess
|
||
side effects, and to provide support and encourage
|
||
adherence. Any more frequent was considered to be
|
||
unnecessary from both an effectiveness and resource impact
|
||
perspective, and would increase the burden for people with
|
||
RA.</p><p>The committee discussed how frequently people should be
|
||
monitored once their disease was below the target activity
|
||
level of remission or low disease activity. The committee
|
||
discussed the previous guideline recommendation, which was
|
||
to provide appointments at a frequency and location suitable
|
||
to [the person’s] needs. The committee agreed that
|
||
this should be more specific if possible, to improve
|
||
consistency and avoid under or over monitoring of this group
|
||
of people. It was agreed by consensus that a review
|
||
appointment should be considered 6 months after a person
|
||
achieves the treatment target, to assess whether the disease
|
||
control has been maintained.</p><p>The committee discussed whether people with sustained disease
|
||
levels below the treatment target required regular
|
||
monitoring between annual reviews in the absence of
|
||
worsening symptoms or deterioration (annual reviews were not
|
||
updated in this guideline). The committee considered the
|
||
study included in the frequency of monitoring review to be
|
||
somewhat applicable to this situation, as it enrolled
|
||
participants with long term, established disease. The
|
||
evidence suggested that patient-initiated rapid access
|
||
(median 8 reviews over 6 years) was no less effective than
|
||
traditionally scheduled medical review every 3-6 months
|
||
(median 13 reviews over 6 years) in this group of people
|
||
with rheumatoid arthritis. The committee acknowledged the
|
||
limitations of this evidence (discussed above), but agreed
|
||
it reflected their experience that regular scheduled
|
||
appointments (over and above an annual review) were not
|
||
necessary in people with well-controlled disease.</p><p>Overall, the committee agreed that once people with
|
||
rheumatoid arthritis had achieved the treatment target, and
|
||
this was sustained at a 6 month follow-up appointment, there
|
||
was no need for additional routine appointments to be
|
||
scheduled other than the annual review. However, the
|
||
committee emphasised the importance of all people with
|
||
rheumatoid arthritis having rapid access to specialist care
|
||
for disease flares, and the need for ongoing drug
|
||
monitoring. The committee agreed this was addressed by the
|
||
existing recommendations on rapid access, which had not been
|
||
reviewed in the update, with some amendments to the wording
|
||
to improve clarity.</p><div id="chd1.s9.1.3.3.1"><h5>People at risk of poor outcomes</h5><p>The committee agreed that there was no evidence
|
||
suggesting people with a poor prognosis should be
|
||
managed any differently to the general rheumatoid
|
||
arthritis population, in terms of the treatment target
|
||
or the frequency of monitoring. The committee agreed
|
||
that the standard recommendations regarding
|
||
treatment-to-target with monthly monitoring should
|
||
ensure that people with a poor prognosis receive
|
||
effective treatment of their disease.</p></div></div></div></div><div id="chd1.s9.2"><h4>1.9.2. Cost effectiveness and resource use</h4><p>For the treat-to-target review, 2 economic evaluations were
|
||
identified, comparing a treat-to-target approach to usual care (Nair
|
||
2015, Grigor 2004). Nair 2015 was a cost–utility analysis
|
||
based on a cohort of people with early RA. This evaluation used
|
||
clinical effectiveness data from the CAMERA trial, which was also
|
||
included in the clinical review for treat-to-target. Analysis within
|
||
this study identified treat-to-target to be cost effective, and in
|
||
fact cost saving compared to usual practice (being less costly and
|
||
more effective). The treat-to-target strategy resulted in less
|
||
medical consumption and improved quality of life due to better
|
||
DAS28/HAQ; however, drug costs were higher. The committee noted the
|
||
relatively short time horizon of the study and questioned the
|
||
ability of the study to capture the long-term cost benefits
|
||
associated with the treat-to-target approach. The second analysis
|
||
(Grigor 2004) was a cost–consequences analysis based on the
|
||
TICORA RCT (same paper) which was also included in the clinical
|
||
review. This analysis also found that treat-to-target was less
|
||
costly and more effective than usual care. No analysis of
|
||
uncertainty was conducted however; confidence intervals indicate
|
||
that there is some uncertainty in both the costs and outcomes. The
|
||
committee considered these confidence intervals and concluded that
|
||
at a minimum treat-to-target was likely to be cost neutral.</p><p>Based on the clinical and economic evidence reviewed, the committee
|
||
concluded that treat-to-target appeared to improve outcomes at no
|
||
additional cost. As treat-to-target is already considered current
|
||
practice and was recommended in the previous guideline, it is not
|
||
anticipated that this recommendation will have a substantial
|
||
resource impact.</p><p>No health economic studies were identified regarding the frequency of
|
||
monitoring or the target for monitoring. Unit costs were provided
|
||
for rheumatologist consultations to aid the consideration of cost
|
||
effectiveness. The committee considered the potential economic
|
||
impact of increasing frequency of monitoring from monthly to
|
||
fortnightly and agreed that this would have a substantial impact on
|
||
NHS resources and that there was no clinical evidence to support it.
|
||
The committee agreed to keep the previous recommendation of monthly
|
||
monitoring based on the clinical evidence reviewed. The committee
|
||
noted that monthly visits may not have been implemented nationwide
|
||
and this is reflected in a survey of the 2009 guideline
|
||
implementation in the Midlands (25–62% receiving monthly
|
||
monitoring). If this is reflective of practice across the country,
|
||
this recommendation will likely involve a change in practice in many
|
||
clinics around the country and may have a resource impact. Although
|
||
there was no direct health economic evidence for the frequency of
|
||
monitoring, the Grigor 2004 and Nair 2015 treat-to-target economic
|
||
analyses suggested that even with more frequent visits (monthly
|
||
versus every 3 months), a treat-to-target approach was cost saving.
|
||
Finally, the committee noted that these monthly visits are often
|
||
conducted by a nurse specialist rather than a consultant. The unit
|
||
costs of different healthcare professionals were presented to the
|
||
committee and it was noted that the cost of a nurse consultation
|
||
would be less expensive than that of a consultant.</p><p>Regarding the target, aiming for low disease activity or remission is
|
||
considered unlikely to have a resource impact. With either target,
|
||
the individual will require ongoing monitoring and treatment
|
||
adjustment, both of which have cost implications that are unlikely
|
||
to differ depending on the target.</p><p>The committee made a recommendation to consider a review appointment
|
||
within 6 months of stabilising. This recommendation was made based
|
||
on expert opinion and consensus. The committee considered that this
|
||
recommendation might reduce unwarranted variation in follow-up
|
||
across the country as the prior recommendation may have led to
|
||
unnecessary consultations for some or others receiving no
|
||
follow-up.</p></div></div></div><div id="ptd.rl.r1"><h2 id="_ptd_rl_r1_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="ptd.ref1">Barlow
|
||
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|
||
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|
||
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|
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|
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Rheumatology. 2015;
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PM,
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JW. Overview
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reporting on remission. Clinical and
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Experimental Rheumatology. 2012;
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30(4 Suppl
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Centre for Chronic Conditions. Rheumatoid
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arthritis: national clinical guideline for management and treatment
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in adults. NICE clinical guideline
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79. London.
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Royal College of Physicians,
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2009. Available from: <a href="http://guidance.nice.org.uk/CG79" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://guidance<wbr style="display:inline-block"></wbr>.nice.org.uk/CG79</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/21413195" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21413195</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="ptd.ref10">National Institute for
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Health and Care Excellence. Developing NICE
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guidelines: the manual.
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London. National
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Institute for Health and Care Excellence,
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2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>.nice.org.uk<wbr style="display:inline-block"></wbr>/article/PMG20/chapter<wbr style="display:inline-block"></wbr>/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="ptd.ref11">Pincus
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T,
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Castrejon
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I. Evidence
|
||
that the strategy is more important than the agent to treat
|
||
rheumatoid arthritis. Data from clinical trials of combinations of
|
||
non-biologic DMARDs, with protocol-driven intensification of therapy
|
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for tight control or treat-to-target.
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Bulletin of the Hospital for Joint Disease
|
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2013; 71 (Suppl
|
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1):S33–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/24219039" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24219039</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="ptd.ref12">Pope
|
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JE,
|
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Haraoui
|
||
B,
|
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Rampakakis
|
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E,
|
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Psaradellis
|
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E,
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Thorne
|
||
C,
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Sampalis
|
||
JS
|
||
et al. Treating to a target in established active
|
||
rheumatoid arthritis patients receiving a tumor necrosis factor
|
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inhibitor: results from a real-world cluster-randomized adalimumab
|
||
trial. Arthritis Care &
|
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Research. 2013;
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65(9):1401–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/23509040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23509040</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="ptd.ref13">Radner
|
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H,
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||
Smolen
|
||
JS,
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||
Aletaha
|
||
D. Remission
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in rheumatoid arthritis: benefit over low disease activity in
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||
patient-reported outcomes and costs.
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Arthritis Research & Therapy.
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2014;
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||
16:R56 [<a href="/pmc/articles/PMC3979137/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3979137</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24555808" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24555808</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="ptd.ref14">Schoels
|
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M,
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||
Knevel
|
||
R,
|
||
Aletaha
|
||
D,
|
||
Bijlsma
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||
JW,
|
||
Breedveld
|
||
FC,
|
||
Boumpas
|
||
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|
||
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|
||
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|
||
Annals of the Rheumatic Diseases.
|
||
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|
||
69(4):638–43 [<a href="/pmc/articles/PMC3015093/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3015093</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20237123" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20237123</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="ptd.ref15">Smolen
|
||
JS,
|
||
Breedveld
|
||
FC,
|
||
Burmester
|
||
GR,
|
||
Bykerk
|
||
V,
|
||
Dougados
|
||
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|
||
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|
||
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|
||
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|
||
update of the recommendations of an international task
|
||
force. Annals of the Rheumatic
|
||
Diseases. 2016;
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|
||
MA,
|
||
Schoels
|
||
MM,
|
||
Smolen
|
||
JS,
|
||
Aletaha
|
||
D,
|
||
Breedveld
|
||
FC,
|
||
Burmester
|
||
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|
||
et al. Evidence for treating rheumatoid arthritis to
|
||
target: results of a systematic literature search
|
||
update. Annals of the Rheumatic
|
||
Diseases. 2016;
|
||
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|
||
Tuyl
|
||
LH,
|
||
Lems
|
||
WF,
|
||
Voskuyl
|
||
AE,
|
||
Kerstens
|
||
PJ,
|
||
Garnero
|
||
P,
|
||
Dijkmans
|
||
BA
|
||
et al. Tight control and intensified COBRA combination
|
||
treatment in early rheumatoid arthritis: 90% remission in a pilot
|
||
trial. Annals of the Rheumatic
|
||
Diseases. 2008;
|
||
67(11):1574–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/18625629" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18625629</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="ptd.ref18">Wells
|
||
G,
|
||
Boers
|
||
M,
|
||
Tugwell
|
||
P, M. D. A. Working
|
||
Group. Low disease activity state in
|
||
rheumatoid arthritis: concepts and derivation of minimal disease
|
||
activity. Clinical and Experimental
|
||
Rheumatology. 2006;
|
||
24(6 Suppl
|
||
43):S-52–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/17083764" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17083764</span></a>]</div></dd></dl></div><div id="appendixes.appgroupd"><h2 id="_appendixes_appgroupd_">Appendices</h2><div id="ptd.appa"><h3>Appendix A. Review protocols</h3><p id="ptd.appa.et1"><a href="/books/NBK577120/bin/ptd-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 3. Review protocol: Which target to monitor in rheumatoid
|
||
arthritis?</a><span class="small"> (PDF, 165K)</span></p><p id="ptd.appa.et2"><a href="/books/NBK577120/bin/ptd-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 4. Health economic review protocol</a><span class="small"> (PDF, 147K)</span></p></div><div id="ptd.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied
|
||
with the methodology outlined in Developing NICE guidelines: the manual
|
||
2014, updated 2017. <a href="https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869</a></p><p><i>For more detailed information, please see the Methodology
|
||
Review</i>.</p><div id="ptd.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P)
|
||
terms were combined with Intervention (I) and in some cases
|
||
Comparison (C) terms. Outcomes (O) are rarely used in search
|
||
strategies for interventions as these concepts may not be well
|
||
described in title, abstract or indexes and therefore difficult to
|
||
retrieve. Search filters were applied to the search where
|
||
appropriate.</p><div id="ptd.appb.tab1" class="table"><h3><span class="label">Table 5</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (Ovid)</td><td headers="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 09 October
|
||
2017</td><td headers="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Randomised controlled
|
||
trials</p>
|
||
<p>Systematic review studies</p>
|
||
</td></tr><tr><td headers="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (Ovid)</td><td headers="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 09 October
|
||
2017</td><td headers="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Randomised controlled
|
||
trials</p>
|
||
<p>Systematic review studies</p>
|
||
</td></tr><tr><td headers="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library
|
||
(Wiley)</td><td headers="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Cochrane Reviews to
|
||
2017</p>
|
||
<p>Issue 10 of 12</p>
|
||
<p>CENTRAL to 2017
|
||
Issue 9 of 12</p>
|
||
<p>DARE, and NHSEED to
|
||
2015</p>
|
||
<p>Issue 2 of 4</p>
|
||
<p>HTA to 2016 Issue 4
|
||
of 4</p>
|
||
</td><td headers="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div><div id="ptd.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Arthritis,
|
||
Rheumatoid/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
||
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
||
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
||
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical
|
||
article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
||
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
||
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal
|
||
experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
||
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tight* adj
|
||
control*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">t2t.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((mission or aiming or aim
|
||
or aimed or aims or achiev* or sustain* or reach*)
|
||
adj2 remission).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((treat* or therap*) adj2
|
||
(target* or goal*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(symptom* adj2 (reduc* or
|
||
improv* or control*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">low disease
|
||
activity.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(abrogat* adj2
|
||
inflammat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">optimi*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-36</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 and 37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
||
trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical
|
||
trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">drug therapy.fs.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">groups.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/39-46</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical Trials as
|
||
topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/39-42,44,48-49</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis as
|
||
Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly*
|
||
or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or
|
||
evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or
|
||
bibliograph* or hand search* or manual search* or
|
||
relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search
|
||
criteria or systematic search or study selection or
|
||
data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4
|
||
literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or
|
||
cochrane or embase or psychlit or psyclit or
|
||
psychinfo or psycinfo or cinahl or science citation
|
||
index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or
|
||
indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/51-60</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38 and (50 or 61)</td></tr></tbody></table></div></div><div id="ptd.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *rheumatoid
|
||
arthritis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
||
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
||
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
||
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case
|
||
study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
||
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
||
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal
|
||
Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental
|
||
Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
||
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tight* adj
|
||
control*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">t2t.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((mission or aiming or aim
|
||
or aimed or aims or achiev* or sustain* or reach*)
|
||
adj2 remission).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((treat* or therap*) adj2
|
||
(target* or goal*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(symptom* adj2 (reduc* or
|
||
improv* or control*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">low disease
|
||
activity.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(abrogat* adj2
|
||
inflammat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">optimi*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27-34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and 35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross
|
||
over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj
|
||
blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or
|
||
volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind
|
||
procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
||
trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind
|
||
procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/37-45</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">meta-analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly*
|
||
or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic or evidence)
|
||
adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or
|
||
bibliograph* or hand search* or manual search* or
|
||
relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search
|
||
criteria or systematic search or study selection or
|
||
data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4
|
||
literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or
|
||
cochrane or embase or psychlit or psyclit or
|
||
psychinfo or psycinfo or cinahl or science citation
|
||
index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or
|
||
indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/47-56</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 and (46 or 57)</td></tr></tbody></table></div></div><div id="ptd.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">[mh “Arthritis,
|
||
Rheumatoid”]</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid near/2
|
||
(arthritis or arthrosis)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* near/2
|
||
syndrome):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* near/2
|
||
syndrome):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid near/2
|
||
factor):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
||
idiopathic) near/2 arthritis):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">inflammatory
|
||
polyarthritis:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#7)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tight* next
|
||
control*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">t2t:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((mission or aiming or aim
|
||
or aimed or aims or achiev* or sustain* or reach*)
|
||
near/2 remission):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((treat* or therap*)
|
||
near/2 (target* or goal*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(symptom* near/2 (reduc*
|
||
or improv* or control*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">low disease
|
||
activity:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(abrogat* near/2
|
||
inflammat*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">optimi*:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #9-#16)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8 and #17</td></tr></tbody></table></div></div></div><div id="ptd.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search
|
||
relating to rheumatoid arthritis population in NHS Economic
|
||
Evaluation Database (NHS EED – this ceased to be updated
|
||
after March 2015) and the Health Technology Assessment database
|
||
(HTA) with no date restrictions. NHS EED and HTA databases are
|
||
hosted by the Centre for Research and Dissemination (CRD).
|
||
Additional searches were run on Medline and Embase for health
|
||
economics studies.</p><div id="ptd.appb.tab5" class="table"><h3><span class="label">Table 6</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 06 October
|
||
2017</td><td headers="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Health
|
||
economics studies</p>
|
||
</td></tr><tr><td headers="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 06 October
|
||
2017</td><td headers="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Health
|
||
economics studies</p>
|
||
</td></tr><tr><td headers="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and
|
||
Dissemination (CRD)</td><td headers="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>HTA - 2001 – 06
|
||
October 2017</p>
|
||
<p>NHSEED - 2001 – 31 March
|
||
2015</p>
|
||
</td><td headers="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div><div id="ptd.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Arthritis,
|
||
Rheumatoid/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
||
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
||
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
||
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical
|
||
article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
||
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
||
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal
|
||
experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
||
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost
|
||
Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics,
|
||
Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics,
|
||
Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics,
|
||
Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and
|
||
Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or
|
||
pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or
|
||
pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or
|
||
utilit* or benefit* or minimi* or unit* or estimat*
|
||
or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or
|
||
fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or
|
||
monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-44</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp models, economic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models, Theoretical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models,
|
||
Organizational/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">markov chains/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Decision Theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte
|
||
carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or
|
||
analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/46-54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 and (45 or 55)</td></tr></tbody></table></div></div><div id="ptd.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *rheumatoid
|
||
arthritis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
||
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
||
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
||
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
||
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
||
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case
|
||
study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
||
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
||
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal
|
||
Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental
|
||
Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
||
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">statistical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic aspect/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 and 28</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*theoretical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*nonbiological model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">stochastic model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision tree/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte
|
||
carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or
|
||
analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-38</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *economic
|
||
evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *health care
|
||
cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or
|
||
pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or
|
||
pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or
|
||
utilit* or benefit* or minimi* or unit* or estimat*
|
||
or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or
|
||
fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or
|
||
monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/40-52</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and (39 or 53)</td></tr></tbody></table></div></div><div id="ptd.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Arthritis,
|
||
Rheumatoid EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((rheumatoid adj2
|
||
(arthritis or arthrosis)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((caplan* adj2
|
||
syndrome))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((felty* adj2
|
||
syndrome))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((rheumatoid adj2
|
||
factor))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((inflammatory or
|
||
idiopathic) adj2 arthritis))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(“inflammatory
|
||
polyarthritis”)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #5
|
||
OR #6 OR #7</td></tr></tbody></table></div></div></div></div><div id="ptd.appc"><h3>Appendix C. Clinical evidence selection</h3><div id="ptd.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20%02018Which%20target%20to%20monitor%20in%20rheumatoid%20arthritis%3F%02019.&p=BOOKS&id=577120_ptdappcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577120/bin/ptdappcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of ‘Which target to monitor in rheumatoid arthritis?’." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of
|
||
‘Which target to monitor in rheumatoid
|
||
arthritis?’</span></h3></div></div><div id="ptd.appd"><h3>Appendix D. Clinical evidence tables</h3><p>No relevant clinical studies were identified.</p></div><div id="ptd.appe"><h3>Appendix E. Forest plots</h3><p>No relevant clinical studies were identified.</p></div><div id="ptd.appf"><h3>Appendix F. GRADE tables</h3><p>No relevant clinical studies were identified.</p></div><div id="ptd.appg"><h3>Appendix G. Health economic evidence selection</h3><div id="ptd.appg.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20chart%20of%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577120_ptdappgf2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577120/bin/ptdappgf2.jpg" alt="Figure 2. Flow chart of economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow chart of economic study selection for the
|
||
guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or
|
||
setting; non-English language</p></div></div></div><div id="ptd.apph"><h3>Appendix H. Health economic evidence tables</h3><p>No relevant economic studies were identified.</p></div><div id="ptd.appi"><h3>Appendix I. Excluded studies</h3><div id="ptd.appi.s1"><h4>I.1. Excluded clinical studies</h4><div id="ptd.appi.tab1" class="table"><h3><span class="label">Table 7</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bykerk 2013<a class="bk_pop" href="#ptd.ref2"><sup>2</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
|
||
are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cardiel 2013<a class="bk_pop" href="#ptd.ref3"><sup>3</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
|
||
are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Edmonds 2007<a class="bk_pop" href="#ptd.ref6"><sup>6</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison.
|
||
conference abstract</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hodkinson 2015<a class="bk_pop" href="#ptd.ref7"><sup>7</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions.
|
||
Inappropriate comparison</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jurgens 2012<a class="bk_pop" href="#ptd.ref8"><sup>8</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
|
||
are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pincus 2013<a class="bk_pop" href="#ptd.ref11"><sup>11</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review:
|
||
literature search not sufficiently rigorous</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pope 2013<a class="bk_pop" href="#ptd.ref12"><sup>12</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate
|
||
comparison</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Radner 2014<a class="bk_pop" href="#ptd.ref13"><sup>13</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study
|
||
design</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schoels 2010<a class="bk_pop" href="#ptd.ref14"><sup>14</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
|
||
are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Smolen 2016<a class="bk_pop" href="#ptd.ref15"><sup>15</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
|
||
are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stoffer 2016<a class="bk_pop" href="#ptd.ref16"><sup>16</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
|
||
are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">van Tuyl 2008<a class="bk_pop" href="#ptd.ref17"><sup>17</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate
|
||
comparison</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wells 2006<a class="bk_pop" href="#ptd.ref18"><sup>18</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design.
|
||
Inappropriate comparison</td></tr></tbody></table></div></div></div><div id="ptd.appi.s2"><h4>I.2. Excluded health economic studies</h4><div id="ptd.appi.tab2" class="table"><h3><span class="label">Table 8</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_ptd.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ptd.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="chd1.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/chd1.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd1.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_chd1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chd1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Adults with RA, with at
|
||
least moderate disease activity (equivalent to DAS28
|
||
≥ 3.2).</p>
|
||
<p>Studies in adults with poor
|
||
prognostic factors will be reviewed
|
||
separately.</p>
|
||
</td></tr><tr><th id="hd_b_chd1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention(s)</th><td headers="hd_b_chd1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Monitoring a composite
|
||
measure of disease activity with a target of
|
||
<b>disease remission</b></p>
|
||
<p>The following
|
||
composite measures will be considered: <ul id="l74"><li id="lt220" class="half_rhythm"><div>Disease activity score 28 (DAS28). DAS28
|
||
< 2.6 = remission</div></li><li id="lt221" class="half_rhythm"><div>Original disease activity score (DAS). DAS
|
||
< 1.6 = remission</div></li><li id="lt222" class="half_rhythm"><div>Simplified disease activity index (SDAI). SDAI
|
||
≤ 3.3 = remission</div></li></ul> The different disease activity measures will
|
||
be pooled in the analysis.</p>
|
||
</td></tr><tr><th id="hd_b_chd1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison(s)</th><td headers="hd_b_chd1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Monitoring a composite
|
||
measure of disease activity with a target of
|
||
<b>low disease activity</b></p>
|
||
<p>The
|
||
following composite measures will be considered:
|
||
<ul id="l75"><li id="lt223" class="half_rhythm"><div>Disease activity score (DAS28; all versions).
|
||
DAS28 < 3.2 = low disease activity</div></li><li id="lt224" class="half_rhythm"><div>Original disease activity score (DAS; all
|
||
versions). DAS < 2.4 = low disease
|
||
activity</div></li><li id="lt225" class="half_rhythm"><div>Simplified disease activity index (SDAI). SDAI
|
||
≤ 11.0 = low disease activity</div></li></ul> The different disease activity measures will
|
||
be pooled in the analysis.</p>
|
||
</td></tr><tr><th id="hd_b_chd1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_chd1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRITICAL <ul id="l76"><li id="lt226" class="half_rhythm"><div>Disease Activity Score (continuous) at 12
|
||
months</div></li><li id="lt227" class="half_rhythm"><div>Quality of life (continuous) at 12 months</div></li><li id="lt228" class="half_rhythm"><div>Function (continuous) at 12 months</div></li></ul> IMPORTANT <ul id="l77"><li id="lt229" class="half_rhythm"><div>Fatigue (continuous) at 12 months</div></li><li id="lt230" class="half_rhythm"><div>Pain (continuous) at 12 months</div></li><li id="lt231" class="half_rhythm"><div>Radiological progression (continuous) at 12
|
||
months</div></li><li id="lt232" class="half_rhythm"><div>Withdrawal/adherence (dichotomous) at longest
|
||
reported time point</div></li></ul></td></tr><tr><th id="hd_b_chd1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_chd1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>RCT</p>
|
||
<p>Systematic review
|
||
of RCTs</p>
|
||
</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="chd1.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">UK costs of healthcare professional visits</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/chd1.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd1.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of appointment</th><th id="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit cost</th><th id="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Source</th></tr></thead><tbody><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GP appointment lasting
|
||
9.22 minutes</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£36</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PSSRU Unit costs 2016<a class="bk_pop" href="#ptd.ref4"><sup>4</sup></a></td></tr><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-admitted face to face
|
||
outpatient follow-up attendance, rheumatology
|
||
(consultant led)</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£137</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs
|
||
2015-2016<a class="bk_pop" href="#ptd.ref5"><sup>5</sup></a></td></tr><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-admitted face to face
|
||
outpatient follow-up attendance, rheumatology
|
||
(non-consultant led)</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£87</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs
|
||
2015-2016<a class="bk_pop" href="#ptd.ref5"><sup>5</sup></a></td></tr><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital based nurse, band
|
||
6, specialist nurse (per working hour/per hour of
|
||
patient contact)</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£44/£108</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PSSRU Unit costs 2016<a class="bk_pop" href="#ptd.ref4"><sup>4</sup></a></td></tr></tbody></table></div></div></div></div><div><p>Final</p></div><div><p>Intervention evidence review</p><p>Developed by the National Guideline Centre, hosted by the Royal College of
|
||
Physicians</p></div><div><p>The recommendations in this guideline represent the view of NICE, arrived at after
|
||
careful consideration of the evidence available. When exercising their judgement,
|
||
professionals are expected to take this guideline fully into account, alongside the
|
||
individual needs, preferences and values of their patients or service users. The
|
||
recommendations in this guideline are not mandatory and the guideline does not
|
||
override the responsibility of healthcare professionals to make decisions
|
||
appropriate to the circumstances of the individual patient, in consultation with the
|
||
patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be
|
||
applied when individual health professionals and their patients or service users
|
||
wish to use it. They should do so in the context of local and national priorities
|
||
for funding and developing services, and in light of their duties to have due regard
|
||
to the need to eliminate unlawful discrimination, to advance equality of opportunity
|
||
and to reduce health inequalities. Nothing in this guideline should be interpreted
|
||
in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in
|
||
other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and
|
||
<a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland
|
||
Executive</a>. All NICE guidance is subject to regular review and may be
|
||
updated or withdrawn.</p></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div><div class="small"><span class="label">Bookshelf ID: NBK577120</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35129925" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35129925</a></span></div></div></div>
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