PMID- 24263144
OWN - NLM
STAT- MEDLINE
DCOM- 20140929
LR  - 20211021
IS  - 1536-7355 (Electronic)
IS  - 1076-1608 (Print)
IS  - 1076-1608 (Linking)
VI  - 19
IP  - 8
DP  - 2013 Dec
TI  - Variability in experts' opinions regarding risks and treatment choices in 
      patients with antineutrophil cytoplasmic antibody-associated vasculitis.
PG  - 426-31
LID - 10.1097/RHU.0000000000000042 [doi]
AB  - OBJECTIVE: There are insufficient toxicity data available to guide treatment 
      decisions in patients with ANCA (antineutrophil cytoplasmic antibody)-associated 
      vasculitis. The objective of this study was to obtain expert input related to 
      available treatment options. METHODS: We performed a Web-based survey of experts 
      (defined as physicians whose practices focus on vasculitis and physicians engaged 
      in research in vasculitis) regarding adverse events (AEs) associated with 
      cyclophosphamide and/or rituximab, the 2 treatment options for remission 
      induction of severe ANCA-associated vasculitis (AAV). Using scaled measures, 
      experts rated (i) the probability of 30 AEs associated with the treatments and 
      (ii) the importance of disclosing each AE and reported (iii) their treatment 
      preferences using standardized scenarios. RESULTS: Ratings of the probabilities 
      of specific AEs associated with cyclophosphamide and rituximab varied 
      significantly among the experts. The majority agreed that AEs related to 
      fertility, infections, and serious infusion reactions were "extremely" or "very 
      important" to disclose. Less than half of the experts surveyed endorsed 
      disclosing the risks of progressive multifocal leukoencephalopathy, hepatitis 
      reactivation, or zoster. For patients with newly diagnosed AAV, the majority of 
      experts preferred intravenous cyclophosphamide for older adults and rituximab for 
      younger women with newly diagnosed AAV. For patients with recurrent disease who 
      had been previously treated with cyclophosphamide, the majority of experts 
      preferred rituximab, regardless of age or sex. CONCLUSIONS: The variability noted 
      in this study suggests that the information and treatment patients receive may 
      differ depending on where they receive their care. This type of unwarranted 
      variability could be reduced if data from long-term extension and observational 
      studies generate more precise outcome estimates for treatment-related AEs in AAV.
FAU - Cozmuta, Raluca
AU  - Cozmuta R
AD  - From the *Yale University School of Medicine, New Haven, CT; daggerDivision of 
      Rheumatology, University of Pennsylvania, Philadelphia, PA; and double daggerClinical 
      Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT.
FAU - Merkel, Peter A
AU  - Merkel PA
FAU - Fraenkel, Liana
AU  - Fraenkel L
LA  - eng
GR  - K24 AR060231/AR/NIAMS NIH HHS/United States
GR  - T32 AR007107/AR/NIAMS NIH HHS/United States
GR  - K24 AR060231-01/AR/NIAMS NIH HHS/United States
GR  - AR060231-01/AR/NIAMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Rheumatol
JT  - Journal of clinical rheumatology : practical reports on rheumatic & 
      musculoskeletal diseases
JID - 9518034
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Immunologic Factors)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - IM
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*drug therapy
MH  - Antibodies, Monoclonal, Murine-Derived/adverse effects/therapeutic use
MH  - Cyclophosphamide/administration & dosage/adverse effects/therapeutic use
MH  - Disclosure
MH  - Health Care Surveys
MH  - Humans
MH  - Immunologic Factors/adverse effects/therapeutic use
MH  - Immunosuppressive Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Informed Consent
MH  - *Practice Patterns, Physicians'
MH  - Risk Assessment
MH  - Rituximab
PMC - PMC3838999
MID - NIHMS487466
COIS- CONFLICT OF INTEREST STATEMENT The authors have no Conflicts of Interest related 
      to the submitted manuscript.
EDAT- 2013/11/23 06:00
MHDA- 2014/09/30 06:00
PMCR- 2014/12/01
CRDT- 2013/11/23 06:00
PHST- 2013/11/23 06:00 [entrez]
PHST- 2013/11/23 06:00 [pubmed]
PHST- 2014/09/30 06:00 [medline]
PHST- 2014/12/01 00:00 [pmc-release]
AID - 00124743-201312000-00002 [pii]
AID - 10.1097/RHU.0000000000000042 [doi]
PST - ppublish
SO  - J Clin Rheumatol. 2013 Dec;19(8):426-31. doi: 10.1097/RHU.0000000000000042.