Template for Patient Group Input

Template for Patient Group Input

to Drugs for Management

of Rheumatoid Arthritis

Email completed forms to by end of day, 24 August 2016

CADTH is undertaking a project to assess the comparative effectiveness and safety of drugs for moderate to severe rheumatoid arthritis, in adult patients who have received treatment.

The review will look at disease-modifying antirheumatic drugs (DMARDs; methotrexate, hydroxychloroquine, sulfasalazine, leflunomide); biologics (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, anakinra, tocilizumab, abatacept, rituximab); small molecules (tofacitinib); subsequent entry biologics (SEBs; infliximab SEB) and drugs in development (adalimumab SEB, etanercept SEB, baricitinib, sarilumab, sirukumab).

For more information on the project, see:

Should you have any questions about completing this form, please contact Sarah Berglas, Patient Engagement Officer at CADTH, by telephone at 613 226 2553 ext. 1335, or email .

• This template form should be used by patient groups to submit patient group input. Individual patients should contact a patient group that is representative of their condition to have their input added to that of the patient group.
• Please provide the input in English and provide your comments within eight pages. You may delete the instructions if you need more space.
• Your patient group input submission, with personal information removed, will be posted on the CADTH website.

Section 1 — General Information

1. Submitting Organization

Please provide an overview of the organization that is making the submission, including the purpose or aims of the organization and an outline of the type of membership.

1. Conflict of Interest Declarations

CADTH requires that all participants in the CADTH reviews disclose any potential conflicts of interest, to ensure that the objectivity and credibility of the CADTH reviews is maintained. Patient groups must declare any interests that may influence or have the appearance of influencing the information submitted. This information is requested for transparency — a declaration of conflict of interest does not negate or preclude the use of the patient input.

a) We have the following declaration(s) of conflict of interest with regard to corporate members and joint working, sponsorship, or funding arrangements:

b)We have the following declaration(s) of conflict of interest with regard to those playing a significant role in compiling this submission:

1. Information-Gathering

Describe how your group obtained the information used to provide input, including the number of patients and caregivers providing perspectives and how you found these individuals.

Section 2 — Treatment Outcomes

1. What would adult patients, their families, and caregivers like drug therapies for moderate to severe rheumatoid arthritis to achieve?

1. If treatment were able to achieve these outcomes, what would it mean for patients’, their families’, and caregivers’ daily activities and quality of life?

Section 3 — Lived Experience

1. From patients’ experiences outside of clinical trials, are there any notable harms or safety concerns with any of the drugs included in this project?

1. Describe any difficulties patients and their families have in using or accessing any of the drugs included in the project.

Section 4 — Additional Information

1. Please provide any additional information related to this project that would be helpful to CADTH.

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