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Updated consensus statement on biological agents, specifically tumour necrosis factor alpha (TNF alpha) blocking agents and interleukin-1 receptor antagonist (IL-1ra), for the treatment of rheumatic diseases, 2004


As in previous years, the consensus group to consider the use of biological agents was constituted by rheumatologists from the Universities of Erlangen, Leiden, and Vienna in Europe in cooperation with other Universities in the USA, Canada, and Europe. Pharmaceutical industry support was obtained from a number of companies, but these institutions had no part in the decisions about the specific programme or about the academic participants at this conference. The perspective of this consensus is from the treating physician’s point of view. The 128 rheumatologists and bioscientists who attended the consensus conference were chosen from a worldwide group of physicians and other scientists from 20 countries with expertise in the use of biological agents for the treatment of rheumatic diseases. The number of attendees and participants were limited so that not everyone who might have been interested could be invited. Additional information has come to light in the past year, corroborating the major positive effect these drugs have had in rheumatoid arthritis (RA) and other rheumatic diseases, as well as further documenting adverse events. Therefore an update of the previous consensus statement1 is appropriate. The consensus statement is annotated to document the credibility of the data supporting it as much as possible. This annotation is that of Shekelle et al2 and is described in appendix 3. As the number of possible references has become so large, sometimes reviews were used and, if they contained category A references, will be referred to as category A evidence. All participants reviewed relevant clinical published articles relating to tumour necrosis factor (TNF) and interleukin (IL)-1 blocking agents. They were given a draft consensus statement and were asked to revise the document in small discussion groups; open discussion of the revisions led to a final document, representing this updated consensus statement.

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