The purpose of the CARRA CTP Advisory Committee is to provide both oversight and support for the CTP development process. The committee develops and revises CTP development guidelines, oversees the CTP development process to ensure consistency of the CARRA name, and provides support to investigators throughout the CTP development process.
Unfortunately, we do not know the “best” way to treat many childhood rheumatic diseases. In many areas of medicine, we have learned what medications are best by conducting large studies where we compare active drugs with placebo. But those studies take a long time, require a lot of patients and cost a lot of money. CARRA would like to be able to compare different treatments that are currently used by monitoring patients carefully over time in the CARRA Registry. However, the information in the Registry can be difficult to interpret when too many different treatments are used. Thus, the CARRA community has developed CARRA Consensus Treatment Plans (CTPS) which are a finite set of treatment options for use in clinical practice. If practitioners use these CTPs in their practice, there will be less variability in treatment between patients, and we will be able to learn more from studying patients who are contributing their data to the CARRA registry.
CARRA CTP development follows a rigorous process, described here.
The CARRA Consensus Treatment Plan (CTP) program was developed so that we can learn more about the effects of different medications from studying patients who are receiving different therapies. The development and approval of new medications for treating childhood rheumatic diseases has been slow. The conduct of randomized controlled trials (link to definition), the approach traditionally used in medical research, is challenged by the need for lots of patients and lots of money. Observational studies are research studies where patients continue to receive treatment as usual from their provider, and information about how they are doing is collected. CARRA collects this information from patients who sign up to be in the CARRA Registry. Through evidence-guided consensus work CARRA members have been developing CTPs for childhood rheumatic diseases. The intent is for the CTPs to be used in routine clinical practice. Use of CTPs in clinical practice reduces treatment variability, thereby allowing for more accurate and reliable comparison of treatment effects when analyzing the observational data collected in the CARRA Registry. A secondary benefit is the availability of CTPs to clinicians with less experience caring for children with rheumatic diseases. It is important to recognize that CTPs are NOT practice guidelines. Practice guidelines require more prior research, and an evidence base which unfortunately is often not available in pediatric rheumatology. And thus, rather than describing a single treatment recommendation as is done with Practice Guidelines, CTPs describe several treatment options already currently in practice, the comparison of which is not currently known.
CARRA investigators have been developing CTPs for several years. Below are some published CTPs.
Several ongoing research studies have been designed to either pilot the CTPs or to perform comparative effectiveness research on patients treated with the CTPs. Below are some completed and published pilot studies.