1. | Demographic data |
Hospital unit: | |
Burton, Cannock, Birmingham City Hospital, Coventry, Derby, Dudley, Hereford, Kings Mill, Leicester, Lincoln, Northampton, Nottingham, Shrewsbury, Solihull, Stoke, University Hospital Birmingham, Warwick, Wolverhampton, Worcester | |
Hospital ID number: | |
Date of birth: | |
Gender: | |
Male, female | |
Rheumatoid factor status: | |
Positive, negative, unknown | |
Anti-CCP status: | |
Positive, negative, unknown | |
How many times did the patient switch (change) their biologic drug in 2011? 1, 2, 3, more than 3 | |
2. | Biologic drug being switched to: |
Abatacept, Adalimumab, Certolizumab, Etanercept, Golilumab, Infliximab, Rituximab, Tocilizumab | |
3. | Biologic drug being switched from: |
Abatacept, Adalimumab, Certolizumab, Etanercept, Golilumab, Infliximab, Rituximab, Tocilizumab | |
4. | Why was the biologic drug in 2. chosen? |
Departmental protocol, risk of tuberculosis/other infection, commissioning restriction, patient choice, research participation, pharmaceutical incentive, physician’s choice | |
5. | Why was the biologic drug in 3. discontinued? |
End of trial, lack of effect, intolerance/adverse event, drug site reaction, cardiac side effects, respiratory side effects, malignancy, neuropathy, demyelination, tuberculosis, septic arthritis, other infection | |
6. | Did the patient continue with the biologic drug in 2. for the next six months? |
Yes, no | |
If Yes, did the DAS-28 score meet NICE response criteria? | |
Yes, no, not assessed | |
7. | Was concomitant Methotrexate used? |
Yes, No | |
If No, what was the reason for not using? | |
Free text | |
8. | Other concomitant DMARDs used at the time of the drug switch: |
Azathioprine, Ciclosporin, Corticosteroids, Cyclophosphamide, Gold, Hydroxychloroquine, Leflunomide, Penicillamine, Sulfasalazine, Other | |
9. | Repeat steps 2. To 8. with successive switches |
10. | Biologic drugs used pre-2011: |
Abatacept, Adalimumab, Certolizumab, Etanercept, Golilumab, Infliximab, Rituximab, Tocilizumab |