2016 December AHPA Newsbrief
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Ontario Medal for Good Citizenship
2017 AHPA Membership Drive
Upcoming Courses and Conferences
Recent Articles and Online Resources
Ontario Medal for Good Citizenship
Congratulations to AHPA’s volunteer webmaster, Jennifer Boyle! Jenn was presented with an Ontario Medal for Good Citizenship on December 1, 2016 by the Honourable Elizabeth Dowdeswell, Lieutenant Governor of Ontario, at a reception at Queen’s Park. The Ontario Medal for Good Citizenship recognizes individuals who, through exceptional long-term efforts, have made outstanding contributions to their communities. Jenn tirelessly donates her time and talents to maintaining AHPA’s website and assisting with administrative duties. This is not her only volunteer work! Jenn volunteers with many other organizations focusing on arthritis. AHPA was proud to be a nominating organization along with some of the other organizations, for which Jenn volunteers. Congratulations Jenn on receipt of this well-deserved medal!
Jennifer Boyle at the awards ceremony with the Honourable Lieutenant Governor, Elizabeth Dowdeswell
The Ninth Annual AHPA Pre-course will be held at the Canadian Rheumatology Association/Arthritis Health Professions Association annual meeting on Wednesday, February 8, 2017 at the Westin Hotel, Ottawa.
There will be a limited number of travel bursaries, available to apply for, please read carefully the information below:
2017 AHPA Membership Drive is Now Open!
This next year is promising to be an exciting year for AHPA members. Thanks so much for all of your continued commitment and involvement with AHPA. We have developed collaborations with different organizations including the Association of Rheumatology Health Professionals (ARHP), Ontario Rheumatology Association (ORA) and Osteoporosis Canada. With these collaborations there will be additional opportunities for our members.
As you know our focus at AHPA continues to be on education and research with the ultimate goal of providing excellent care for patients with arthritis. Your renewal as a member will continue to provide you with opportunities to stay current, share knowledge and expertise, network, take part in annual conferences, apply for research grants, and more.
For the next year there will be openings on our board and therefore opportunities to become more involved as a board member. We welcome and need new members on our board. If you are interested please watch our website for nomination details.
We hope that you will renew your membership with AHPA.
Please login to www.ahpa.ca to renew your membership.
Upcoming Courses and Conferences
Date: February 8th 2017
Location: Ottawa, Ontario
For more information: www.ahpa.ca
Canadian Rheumatology Association Annual Scientific Meeting
Date: February 8-11th 2017
Location: Ottawa, Ontario
For more information and to register: www.rheum.ca
Assessment and Management of Rheumatic Diseases is a 4-day skills workshop for physical therapists, occupational therapists and nurses.
Date: April 3 – 6, 2017
Location: Mary Pack Arthritis Centre, Vancouver, British Columbia
Cost: $656.25 ($625 + $31.25 GST)
Key benefits of attending:
* Update your knowledge of evidence-based care for three common forms of arthritis
* Practice hands-on assessment skills with patient models
* Learn from multidisciplinary instructors and case studies
* Registration deadline is March 3, 2017
For more information and a copy of the workshop brochure visit http://mpap.vch.ca/resources-for-professionals/becoming-an-ace-member or contact email@example.com (mailto:firstname.lastname@example.org)
Bone Fit Workshops - Osteoporosis Canada
Stay tuned for workshops in 2017!
This evidence-informed exercise training workshop is designed for healthcare professionals & exercise practitioners to provide training on the most appropriate, safe & effective methods to prescribe & progress exercise for people with osteoporosis.
Recent Articles and Online Resources
Cost-Effectiveness of Triple Therapy Versus Etanercept Plus Methotrexate in Early Aggressive Rheumatoid Arthritis
Jalal, H., O’Dell, J. R., Bridges, S. L., Cofield, S., Curtis, J. R., Mikuls, T. R., Moreland, L. W. and Michaud, K. (2016), Cost-Effectiveness of Triple Therapy Versus Etanercept Plus Methotrexate in Early Aggressive Rheumatoid Arthritis. Arthritis Care Res, 68: 1751–1757. doi: 10.1002/acr.22895
To evaluate the cost-effectiveness of all 4 interventions in the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) clinical trial: immediate triple (IT), immediate etanercept (IE), step-up triple (ST), and step-up etanercept (SE). Step-up interventions started with methotrexate and added either etanercept or sulfasalazine plus hydroxychloroquine to patients with persistent disease activity.
We built a Markov cohort model that uses individual-level data from the TEAR trial, published literature, and supplemental clinical data. Costs were in US dollars, benefits in quality-adjusted life years (QALYs), perspective was societal, and the time horizon was 5 years.
The immediate strategies were more efficacious than step-up strategies. SE and IE were more costly than ST and IT, primarily due to treatment cost differences. In addition, IT was the least expensive and most effective strategy when the time horizon was 1 and 2 years. When the time horizon was 5 years, IE was marginally more effective than IT (3.483 versus 3.476 QALYs), but IE was substantially more expensive than IT ($148,800 versus $52,600), producing an incremental cost-effectiveness ratio of $12.5 million per QALY. These results were robust to both one-way deterministic and joint probabilistic sensitivity analyses.
IT was highly cost-effective in the majority of scenarios. Although IE was more effective in 5 years, a substantial reduction in the cost of biologic agents was required in order for IE to become cost-effective in early aggressive RA under willingness-to-pay thresholds that most health care settings may find acceptable.
Mapping Perceptions of Lupus Medication Decision-Making Facilitators: The Importance of Patient Context
Qu, H., Shewchuk, R. M., Alarcón, G., Fraenkel, L., Leong, A., Dall’Era, M., Yazdany, J. and Singh, J. A. (2016), Mapping Perceptions of Lupus Medication Decision-Making Facilitators: The Importance of Patient Context. Arthritis Care Res, 68: 1787–1794. doi: 10.1002/acr.22904
Numerous factors can impede or facilitate patients’ medication decision-making and adherence to physicians’ recommendations. Little is known about how patients and physicians jointly view issues that affect the decision-making process. Our objective was to derive an empirical framework of patient-identified facilitators to lupus medication decision-making from key stakeholders (including 15 physicians, 5 patients/patient advocates, and 8 medical professionals) using a patient-centered cognitive mapping approach.
We used nominal group patient panels to identify facilitators to lupus treatment decision-making. Stakeholders independently sorted the identified facilitators (n = 98) based on their similarities and rated the importance of each facilitator in patient decision-making. Data were analyzed using multidimensional scaling and hierarchical cluster analysis.
A cognitive map was derived that represents an empirical framework of facilitators for lupus treatment decisions from multiple stakeholders’ perspectives. The facilitator clusters were 1) hope for a normal/healthy life, 2) understand benefits and effectiveness of taking medications, 3) desire to minimize side effects, 4) medication-related data, 5) medication effectiveness for “me,” 6) family focus, 7) confidence in physician, 8) medication research, 9) reassurance about medication, and 10) medication economics.
Consideration of how different stakeholders perceive the relative importance of lupus medication decision-making clusters is an important step toward improving patient-physician communication and effective shared decision-making. The empirically derived framework of medication decision-making facilitators can be used as a guide to develop a lupus decision aid that focuses on improving physician-patient communication.
Ustekinumab Treatment and Improvement of Physical Function and Health-Related Quality of Life in Patients With Psoriatic Arthritis
Rahman, P., Puig, L., Gottlieb, A. B., Kavanaugh, A., McInnes, I. B., Ritchlin, C., Li, S., Wang, Y., Song, M., Mendelsohn, A., Han, C. and on behalf of the PSUMMIT 1 and 2 Study Groups (2016), Ustekinumab Treatment and Improvement of Physical Function and Health-Related Quality of Life in Patients With Psoriatic Arthritis. Arthritis Care Res, 68: 1812–1822. doi: 10.1002/acr.23000
To examine the effects of ustekinumab on patient-reported outcomes (PROs) in PSUMMIT 1 and PSUMMIT 2 patients with active psoriatic arthritis (PsA) who were methotrexate (MTX) naive, MTX experienced, or anti–tumor necrosis factor (TNF) experienced.
Patients in the phase 3, PSUMMIT 1 (n = 615) and PSUMMIT 2 (n = 312) studies randomly (1:1:1) received placebo, ustekinumab 45-mg, or ustekinumab 90-mg subcutaneous injections at weeks 0, 4, 16, 28, 40, and 52. The PROs (Health Assessment Questionnaire [HAQ] disability index [DI], Dermatology Life Quality Index [DLQI], 36-Item Short Form [SF-36] health survey physical (PCS) and mental component summary scores, patient assessments of pain and disease activity, and impact of disease on productivity) were assessed at weeks 0, 24, and 52. In these post hoc analyses, outcomes were compared between the ustekinumab and placebo groups for 3 mutually exclusive antecedent-exposure populations from the combined studies: MTX/anti-TNF naive (placebo, n = 56; 45 mg, n = 58; and 90 mg, n = 66), MTX experienced, biologic agent naive (placebo, n = 192; 45 mg, n = 190; and 90 mg, n = 185), and anti-TNF experienced with or without MTX (placebo, n = 62; 45 mg, n = 60; and 90 mg, n = 58).
At week 24, mean improvements from baseline in HAQ DI, DLQI, and SF-36 PCS scores were significantly greater in both ustekinumab groups versus placebo across antecedent-exposure groups. Greater proportions of ustekinumab-treated than placebo-treated patients (all P < 0.05) had clinically meaningful improvements in HAQ DI (≥0.3), DLQI (≥5), and SF-36 (≥5) scores at week 24, irrespective of drug exposure. Improvements in pain, disease activity, and impact of disease on productivity were similar, and benefits were maintained through week 52.
Significant improvements in PROs with ustekinumab versus placebo were observed in 3 antecedent-exposure populations of PsA patients, including those with prior MTX and anti-TNF use.
Risk of Infection Associated With Subsequent Biologic Agent Use After Rituximab: Results From a National Rheumatoid Arthritis Patient Registry
Harrold, L. R., Reed, G. W., Karki, C., Magner, R., Shewade, A., John, A., Kremer, J. M. and Greenberg, J. D. (2016), Risk of Infection Associated With Subsequent Biologic Agent Use After Rituximab: Results From a National Rheumatoid Arthritis Patient Registry. Arthritis Care Res, 68: 1888–1893. doi: 10.1002/acr.22912
To assess whether the time between the last rituximab infusion and initiation of a different biologic agent influenced infection risk in patients with rheumatoid arthritis (RA).
Patients with RA who newly initiated rituximab within the Consortium of Rheumatology Researchers of North America registry were included if they switched to a nonrituximab biologic agent and had ≥1 followup visit within 12 months of switching. Patients were categorized by duration of time between their last rituximab infusion and initiation of a subsequent biologic agent (≤5 months, 6–11 months, and ≥12 months). The primary outcome was time to first infectious event. Adjusted Cox regression models estimated the association between time to starting a subsequent biologic agent and infection.
A total of 44 overall infections (7 serious, 37 nonserious) were reported during the 12-month followup in the 215 patients included in this analysis (104 switched at ≤5 months, 67 at 6–11 months, and 44 at ≥12 months). Median (interquartile range) time to infection was 4 (2–5) months. Infection rates per patient-year in the ≤5-month, 6–11-month, and ≥12-month groups were 0.34 (95% confidence interval [95% CI] 0.22–0.52), 0.30 (95% CI 0.17–0.52), and 0.41 (95% CI 0.22–0.77), respectively. After adjustment, time to switch to a subsequent biologic agent was not associated with infection, which remained unchanged when number and rate of rituximab retreatments were included in the models.
In this real-world cohort of patients with RA, infection rates ranged from 0.30 to 0.41 per patient-year, with no significant difference in the rate between patients who initiated a subsequent biologic agent earlier versus later after rituximab treatment.
Next News Brief Deadline
The deadline for the January newsletter will be December 30th 2016. Please send any contributions to Julia Farquharson at Julia.email@example.com. We are particularly interested in notices of conferences or workshops, new resources for patients or health professionals and summaries of recent research/publications. We welcome contributions from members from all parts of the country.