Evidence map›Paper›PMID 39375683›Full record

Observational studyPediatric rheumatology online journal2024

Implementation study of the CARRA Uveitis Consensus Treatment Plans: feasibility for clinical practice and applicability for research.

Margaret H Chang, Fatima Barbar-Smiley, Shoghik Akoghlanian, Joanne Drew, Sheila T Angeles-Han, Megan Quinlan-Waters, John F Bohnsack, Ashley M Cooper, Barbara Edelheit, Jennifer Twachtman-Bassett and 5 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Pediatric rheumatology online journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Margaret H Chang *Division of Immunology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Fegan 6 Boston, Boston, MA, 02115, USA.
Fatima Barbar-Smiley *Amgen Inc, Thousand Oaks, CA, USA.
Shoghik AkoghlanianDepartment of Rheumatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
Joanne DrewDepartment of Rheumatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
Sheila T Angeles-HanDivision of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA.
Megan Quinlan-WatersDivision of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA.
John F BohnsackDivision of Pediatric Rheumatology, University of Utah Eccles School of Medicine, Salt Lake City, UT, USA.
Ashley M CooperChildren's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Barbara EdelheitDepartment of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
Jennifer Twachtman-BassettDepartment of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
Melissa A LermanDivision of Rheumatology, Department of Pediatrics, Perelman School of Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
Kabita NandaDivision of Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
C Egla RabinovichDivision of Pediatric Rheumatology, Duke University, Durham, NC, USA.
Mindy S LoDivision of Immunology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Fegan 6 Boston, Boston, MA, 02115, USA. mindy.lo@childrens.harvard.edu.
CARRA Uveitis Workgroup and the CARRA Registry Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic anterior uveitis (CAU) carries a significant risk for eye complications and vision loss. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) introduced consensus treatment plans (CTPs) to standardize treatment for CAU and facilitate future comparative effectiveness studies. Two CTPs were developed to address: 1) initiation of methotrexate (MTX) in patients with CAU naïve to steroid-sparing therapy, and 2) initiation of a TNF inhibitor (TNFi) in patients with severe uveitis or uveitis refractory to MTX. We evaluated implementation of the uveitis CTPs using existing CARRA Registry infrastructure and assessed feasibility of the CTPs for comparative effectiveness research.

methodsThis prospective observational cohort study was conducted at nine pilot sites between February 2020 and August 2022. Patients with JIA-associated CAU (JIA-U) were treated according to either the MTX or TNFi CTP. Uveitis activity and medication use were recorded at 0, 3, and 6 months. We assessed patient enrollment rates, CTP arm selection, uveitis control, and quality of data collection. We also evaluated CTP arm selection in a retrospective cohort of similar JIA-U patients enrolled in the CARRA Registry during the same study period.

resultsSeventeen patients were included in the pilot cohort. Eight were treated with the MTX CTP (4 oral MTX, 4 subcutaneous MTX), and 9 with the TNFi CTP (9 received standard-dose adalimumab, none selected high-dose adalimumab or infliximab). Uveitis was controlled in 13 of 17 patients by 6 months. Query of the CARRA-wide Registry identified 42 patients with JIA-U who were treated according to the MTX or TNFi CTPs. Among these, 26 were treated with MTX (8 oral, 18 subcutaneous) and 16 with TNFi (12 standard dose adalimumab, 2 high dose adalimumab, and 2 infliximab).

conclusionBoth the MTX and TNFi uveitis CTPs can practically be implemented in clinical settings and are currently being utilized across Registry sites. However, in patients starting TNFi therapy, all pilot study participants and most patients across the CARRA Registry were treated with a standard dose of adalimumab. This consensus on the treatment approach underscores its broad acceptance but also limits the applicability of the uveitis TNFi CTP for comparative effectiveness research.

Indexed as

Feasibility StudiesMethotrexateTumor Necrosis Factor InhibitorsAdolescentAntirheumatic AgentsArthritis, JuvenileChildComparative Effectiveness ResearchConsensusFemaleHumansMalePilot ProjectsPractice Guidelines as TopicProspective StudiesRegistriesAntirheumatic AgentsMethotrexateTumor Necrosis Factor InhibitorsAdalimumabComparative effectivenessConsensus treatment planInfliximabJuvenile idiopathic arthritisMethotrexateUveitis

Identifiers

PMID39375683
PMCPMC11457454

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.