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G362 Survey and pilot audit of the use of etanercept in children and young people with juvenile idiopathic arthritis against NICE guidance (TA35)
  1. J Burgess1,
  2. C Woodward1,
  3. C Nash1,
  4. LJ McCann2,
  5. CE Pain2,
  6. K Khawaja3,
  7. KE Haslam3,
  8. D Barretto4,
  9. K Armon4,
  10. V Clarke4,
  11. DP Hawley1
  1. 1Paediatric Rheumatology, Sheffield Childrens Hospital NHS Foundation Trust., Sheffield, UK
  2. 2Paediatric Rheumatology, Alder Hey Hospital NHS Foundation Trust, Liverpool, UK
  3. 3Paediatric Rheumatology, Bradford Hospital NHS Foundation Trust, Bradford, UK
  4. 4Paediatric Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK

Abstract

Etanercept is efficacious in juvenile idiopathic arthritis (JIA) and was licensed for this indication in 2001. NICE published guidance on its use in 2002 [1]. 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.

Aims

  1. Survery attitudes towards auditing etanercept use

  2. 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 [1]. 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 :

    1. In non-polyarticular course JIA

    2. When <5 joints swollen or <3 joints limited movement and tender

    3. 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.

Conclusions Pilot audit data suggests out-dated guidance is not being adhered to. Positive opinion was reported for:

  • Multi-centre audit of NICE TA35 guidance

  • Collaborative working toward updating guidance

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