Etanercept is efficacious in juvenile idiopathic arthritis (JIA) and was licensed for this indication in 2001. NICE published guidance on its use in 2002 . Subsequent evidence has stimulated different prescribing patterns to those of the guidance [2–4] however commissioning may continue to rely on out-dated guidance as a measure of good practice.
Survery attitudes towards auditing etanercept use
Pilot a multi-centre audit of etanercept use in JIA
Methods An online survey was distributed to paediatric rheumatologists at 14 centres to establish if recent auditing (within 2 years) had been undertaken or if future audit of etanercept use against NICE guidance was planned . A proposed multi-centre audit was piloted at four UK centres.
Results Twenty survey responses revealed 11(58%) respondents had audited and 11 (58%) (including one who was planning to re-audit) were planning to audit current practice against NICE guidance. Responses were favourable towards a national multi-centre audit. Updating guidance on etanercept use (and other biologics) was highlighted as important. Pilot audit data for 100 cases revealed adherence to NICE guidance in 21%. See attached table. Key areas of non-compliance were:
1. Etanercept use :
In non-polyarticular course JIA
When <5 joints swollen or <3 joints limited movement and tender
In patients outside the ages 4–17 year
4. Dose of methotrexate prescribed prior to etanercept initiation
Table: Table showing summary of audit data collected in three centres.