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Consistency of recommendations for pharmacotherapy of rheumatoid arthritis

Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Hu, Yue;
Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Han, Yunze;
Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Ma, Yan;
Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Fan, Shumei;
Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Wang, Xue;
Affiliation
School of Stomatology ,Lanzhou University ,Lanzhou ,China
Fu, Xinyu;
Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Hu, Xiaopeng;
Affiliation
Evidence-Based Medicine Center ,School of Basic Medical Sciences ,Lanzhou University ,Lanzhou ,China
Luo, Xufei;
Affiliation
School of Chinese Medicine ,Hong Kong Baptist University ,Hong Kong ,Hong Kong SAR, China
Ma, Yanfang;
Affiliation
Evidence-Based Medicine Center ,School of Basic Medical Sciences ,Lanzhou University ,Lanzhou ,China
Xun, Yangqin;
Affiliation
Evidence-Based Medicine Center ,School of Basic Medical Sciences ,Lanzhou University ,Lanzhou ,China
Yang, Nan;
Affiliation
Zhejiang University of Traditional Chinese Medicine ,Hangzhou ,Zhejiang ,China
Wen, Chengping;
Affiliation
Wangjing Hospital ,China Academy of Chinese Medical Sciences ,Beijing ,China
Cao, Wei;
Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Song, Xuping;
Affiliation
School of Public Health ,Lanzhou University ,Lanzhou ,China
Chen, Yaolong

Background: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory arthropathy. Recommendations for RA, specifically on pharmacotherapy, are essential in clinical practice. However, the direction and strength of recommendations are controversial across current clinical practice guidelines (CPGs) of RA. Objective: To systematically analyze the consistency of recommendations regarding pharmacotherapy of RA across CPGs. Methods: 11 electronic databases and websites were comprehensively searched from inception to 14 March 2022, to identify CPGs for diagnosis, therapy, and management of RA. Unambiguous and discrete specifications of the population-intervention-comparison (PIC) framework were used to classify the recommendations. Based on the PIC framework, consistency analyses across CPGs on pharmacotherapy of RA were performed. Two researchers reached a consensus on coding the direction and strength of each recommendation. Results: Finally, 26 CPGs were included in this study, and 14 of them, which included pharmacotherapy, were performed consistency analysis. 1) 64 recommendations from 14 CPGs were classified into 18 PICs. 2) Seven PICs (38%) were consistent in direction and strength, 10 PICs (56%) were consistent in direction but inconsistent in strength, and one PIC (6%) was inconsistent in direction (hydroxychloroquine, HCQ). 3) Sensitivity analysis tested the robustness, and the inconsistency remained high. Conclusion: The direction was highly consistent among the recommendations of pharmacotherapy for RA, but the strength was highly inconsistent. Reasons for the inconsistency need to be further investigated, and consistent recommendations could guide the pharmacotherapy of RA in clinical practice.

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License Holder: Copyright © 2022 Hu, Han, Ma, Fan, Wang, Fu, Hu, Luo, Ma, Xun, Yang, Wen, Cao, Song and Chen.

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