The development of a risk threshold to aid risk stratified approach to monitoring for haematological, hepatic and/or renal adverse drug reactions during established cs DMARD treatment for systemic autoimmune rheumatic diseases: a RAND/UCLA Appropriateness Method consensus study
Authors' conclusion
A threshold to aid risk-stratified monitoring during established csDMARD treatment was agreed for adults with SARD.
Study context
- Population
- Members of the BSR csDMARD guideline working group who manage adults with systemic autoimmune rheumatic diseases (SARD); scenarios of adults prescribed csDMARDs for ≥1 year for SARDof 27 invitees
- Participants
- 21 members
- Outcome
- Appropriateness of intervals between monitoring blood tests by 5-year predicted risk of discontinuing treatment due to abnormal monitoring blood tests (5% to 25%); consensus = median panel score ≥7 and up to six experts rating <7
Methodological detailsRAND/UCLA Appropriateness Method, two rounds (scenarios without agreement recirculated), 9-point Likert-type scales, nine scenarios, Panel: 11 consultants/GPs, 5 specialist nurses, 3 pharmacists, 2 rheumatology specialty trainees, Results discussed with patient and public involvement members and experts
- RAND/UCLA Appropriateness Method
- Two rounds (scenarios without agreement recirculated)
- 9-point Likert-type scales
- Nine scenarios
- Panel: 11 consultants/GPs, 5 specialist nurses, 3 pharmacists, 2 rheumatology specialty trainees
- Results discussed with patient and public involvement members and experts
Recommendations
As reported in the abstract
Appropriate monitoring interval by 5-year predicted risk
- Consensus reached for all scenarios
- 6-monthly blood tests appropriate when predicted 5-year risk ≤10%
- 3-monthly blood tests appropriate when predicted 5-year risk >10%
Original publication
The development of a risk threshold to aid risk stratified approach to monitoring for haematological, hepatic and/or renal adverse drug reactions during established cs DMARD treatment for systemic autoimmune rheumatic diseases: a RAND/UCLA Appropriateness Method consensus study. Rheumatology (Oxford). Published 3 February 2026. doi:10.
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