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• W4211192011 abstract "To analyse factors involved in the decision to optimise biologics in juvenile idiopathic arthritis. A “discrete-choice” methodology was used. In a nominal group meeting, factors which may influence physicians’ decisions to optimise biological dose were identified, together with decision nodes. 1000Minds® was used to create multiple fictitious clinical scenarios based on the factors identified, and to deploy surveys that were sent to a panel of experts. These experts decided for each item which of two clinical scenarios prompted them to optimise the dose of biologic. A conjoint analysis was carried out, and the partial-value functions and the weights of relative importance calculated. In the nominal group, three decision nodes were identified: (1) time to decide; (2) to maintain/reduce or prolong interval; (3) what drug to reduce. The factors elicited were different for each node and included patient and drug attributes. The presence of macrophage activation syndrome (MAS), systemic involvement, or subclinical inflammation made the decision easier (highest weights). The presence of joints of difficult control and year of debut influenced the decision in some but not all, and in different directions. Immunogenicity, adherence, and concomitant treatments were also aspects taken into account. The decision to optimise the dose of biological therapy in children and youngster can be divided into several nodes, and the factors, both patient and therapy-related, leading to the decision can be detailed. These decisions taken by experts may be transported to practice, study designs, and guidelines. Analizar los factores que intervienen en la decisión de optimizar el biológico en la artritis idiopática juvenil. Se utilizó la metodología de «elección discreta». Mediante grupo nominal se identificaron factores potencialmente influyentes en la decisión de optimizar la dosis de biológico y los nodos de decisión. Con 1000Minds® se crearon escenarios clínicos ficticios basados en los factores identificados que se mostraron en encuestas a un panel de expertos. Cada ítem de las encuestas mostraba 2 escenarios clínicos y los expertos elegían el que les llevaría a optimizar el biológico. Se realizó un análisis conjunto, calculándose las funciones de valor parcial y los pesos de importancia relativa. Se identificaron 3 nodos de decisión: 1) dilatar decisión o no; 2) mantener/reducir o prolongar el intervalo; y 3) qué fármaco reducir. Los factores identificados varían por nodo e incluyen atributos del paciente y del fármaco. La presencia del síndrome de activación macrofágica, la afectación sistémica o la inflamación subclínica facilitaron la decisión (pesos más altos). La presencia de articulaciones de difícil control y el año de inicio influyeron en la decisión en algunos casos, pero no en todos, y en diferentes direcciones. La inmunogenicidad, la adherencia y los tratamientos concomitantes también fueron aspectos decisivos. La decisión de optimizar la dosis de biológico en artritis idiopática juvenil se divide en varios nodos y se pueden detallar factores, tanto del paciente como del tratamiento, que determinan la decisión. Estas decisiones de experto pueden transportarse a la práctica, la investigación y las recomendaciones." @default.
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• W4211192011 date "2023-01-01" @default.
• W4211192011 modified "2023-09-26" @default.
• W4211192011 title "What drives the decision to optimise biological treatment in children and youngsters with juvenile idiopathic arthritis? A discrete-choice experiment" @default.
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• W4211192011 doi "https://doi.org/10.1016/j.reuma.2021.12.003" @default.
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