Updated German Clinical Practice Guideline on "Diagnosis and treatment of Crohn's disease" 2014 AWMF registration no.: 021-004
J. PreißBernd BokemeyerH. J. BuhrAxel DignaßW. HaeuserF HartmannKlaus HerrlingerBarbara KaltzPatricia C. KienleWolfgang KruisTorsten KucharzikJost LanghorstStefan SchreiberBritta SiegmundAndreas StallmachEF StangeJürgen M. SteinJörg Hoffmann
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Abstract This evidence‐ and consensus‐based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The first part of the guideline includes general information on the scope and purpose, health questions covered, target users and strength/limitations of the guideline. Suggestions for disease severity grading and treatment goals are provided. It presents the general treatment recommendations as well as detailed management and monitoring recommendations for the individual drugs. The treatment options discussed in this guideline are as follows: acitretin, ciclosporin, fumarates, methotrexate, adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab.
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Objectives: Using an expert- and data-driven methodology, we have constructed the first clinical practice guidelines (CPGs) for adult Still's disease (ASD) after complete systematic review (SR) of the literature based upon the Medical Information Network Distribution Service (Minds) procedure.Methods: The CPG committee for ASD organized by the Research Team for Autoimmune Diseases, the Research Program for Intractable Disease of the Japanese Ministry of Health, Labour, and Welfare has developed CPG for ASD 2017, according to the procedure proposed by Minds. The CPG development process includes (1) clarification of the purpose of CPG, (2) organization of the steering committee, (3) organization of the CPG committee and secretariat, (4) defining the scope (setting of clinical questions (CQs)), (5) SR, (6) development of recommendations, (7) drafting the CPG, (8) external evaluation and public comments, and (9) release. Because we wanted to construct CPG for ASD to encompass both adult-onset Still's disease (AOSD) and adult patients with systemic juvenile idiopathic arthritis (sJIA), we also included SR data from sJIA in this study.Results: Twenty-six CQs were selected and roughly divided into the following items: (1) clinical findings (CQs 1–4), (2) laboratory findings (CQs 5–8), (3) complications (CQs 9–13), (4) treatment with oral medicine (CQs 14–19), (5) treatment with biological reagents (CQs 20–23), and (6) treatments for sJIA (CQs 25–26). Recommendations and the strength of the recommendations for these CQs were decided by a modified Delphi method.Conclusion: We have developed the first published CPG for ASD including AOSD and sJIA, which includes 26 CQs and recommendations. This guideline will help rheumatologists, non-specialized physicians, other healthcare providers, medical and health-related students, and patients and their family members to understand and treat ASD.
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In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Germany, Switzerland, and the Czech Republic.
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Der Morbus Crohn (ICD-10: K50) ist neben der Colitis ulcerosa (ICD-10: K51) die wichtigste chronisch-entzündliche Darmerkrankung. Für den M. Crohn wurde in Deutschland zuletzt eine Inzidenz bis 6,6 pro 100 000 Einwohner berichtet [1]. Die Prävalenz dürfte bei 100 – 200 pro 100 000 Einwohner liegen [2] [3]. Die höchste altersspezfische Inzidenz liegt im dritten Lebensjahrzehnt, das mediane Erkrankungsalter bei 33 Jahren [4]. Somit beginnt für die meisten Patienten mit M. Crohn ihre Erkrankung während der Berufsausbildung und dauert während ihres gesamten beruflichen Lebens an. Daraus folgt, dass durch die Erkrankung nicht nur direkte Kosten (Medikamente, Arztbesuche, Operationen, Krankenhausaufenthalte etc.), sondern auch umfangreiche indirekte Kosten (Rente, Arbeitsausfälle etc.) entstehen. Es ist davon auszugehen, dass bei Patienten mit M. Crohn fast zwei Drittel (64 %) der Gesamtkosten den indirekten Kosten zuzuordnen sind [5]. An direkten medizinischen Kosten wurden dabei zuletzt zwischen 3500 und 6000 € pro Jahr für einen Patienten mit M. Crohn errechnet. Insgesamt entfielen 69 % der direkten Kosten allein auf Arzneimittelkosten [5] [6]. Hochgerechnet werden allein in Deutschland 2 – 3 Milliarden Euro pro Jahr für die Versorgung von Patienten mit M. Crohn aufgewandt.
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The German guideline for the treatment of psoriasis vulgaris was updated using GRADE methodology. The guideline is based on a systematic literature review completed on December 1, 2016, and on a formal consensus and approval process. The first section of this short version of the guideline covers systemic treatment options considered relevant by the expert panel and approved in Germany at the time of the consensus conference (acitretin, adalimumab, apremilast, cyclosporine, etanercept, fumaric acid esters, infliximab, methotrexate, secukinumab and ustekinumab). Detailed information is provided on the management and monitoring of the included treatment options.
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