Spring 2019 (Volume 29, Number 1)
The Rheumatoid Arthritis
Pharmacovigilance Program and
Outcomes Research in Therapeutics
(RAPPORT)
By Walter P. Maksymowych, MD, FRCPC
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The Rheumatoid Arthritis Pharmacovigilance Program
and Outcomes Research in Therapeutics (RAPPORT)
Prospective Inception Cohort became operational in
2004 with two primary aims:
A. To enhance the education and care of patients receiving
biologics for the treatment of rheumatoid arthritis and;
B. To systematically capture data on the safety, effectiveness,
and cost-benefit of treatment with biologics.
The program was launched province-wide with the
same database at the Universities of Alberta and Calgary.
Since then, the program has accumulated data on
almost 3,000 patients from both academic and community-based practices, expanded the scope of patient-care
activities to include routine vaccination and management
of disease-related comorbidities, and embraced patients
receiving an ever-expanding array of complex therapies
for rheumatoid arthritis. Efficacy outcomes are those
routinely employed in clinical trials while safety has been
systematically assessed using the Outcome Measures in
RheumAtology Clinical Trials (OMERACT) framework.
Cost-benefit analysis has been possible because of a
unique linkage between outcomes captured in the clinic
and administrative data provided by Alberta Health and
Wellness. A major finding of analyses from the RAPPORT
database has been the extraordinary health-care expenditures
incurred in the management of both RA-related
and non-RA-related comorbidities, especially in patients
failing treatment with their first biologic. Conversely, this
analysis has also shown dramatic reductions in healthcare
utilization related to surgery, outpatient costs, physiotherapy,
and in-patient stays in patients who do respond
to treatment.
Two recent enhancements to the program have included
direct online data entry on a tablet PC by patients at the
time of the clinic visit and provision of real-time outcomes
data for the attending rheumatologist to enhance treat-to-target
management strategies. The program has been possible
and continues to be successful because of the dedication
and expertise of our allied health professionals. It will
continue to grow because it has clearly been shown to serve
a vital need for our patients and health care providers.
Walter P. Maksymowych, MD, FRCPC
Professor of Medicine,
Department of Medicine,
Division of Rheumatology,
University of Alberta
Edmonton, Alberta
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