The landscape of comparative effectiveness research in rheumatology

Journal name:
Nature Reviews Rheumatology
Year published:
Published online


Comparative effectiveness research (CER) is a growing area of investigation aimed at determining the most beneficial treatments for patients in view of their clinical characteristics. CER provides personalized treatment information that cannot be obtained from traditional clinical trials. However, many analytical challenges to performing CER remain, particularly in nonexperimental settings. The main obstacles to CER include bias from variation in use of treatments, and heterogeneity in types and quality of data across registries. Increasing standardization of care and consensus among stakeholders regarding CER methodology will strengthen the validity of CER from observational data. Innovations in outcomes measurement, and the ability to repurpose electronic health record data for research will increase the capability to assess treatment effects by CER in clinical practice. Investment in infrastructure, informatics, and data management to sustain high-quality registries, along with engagement of stakeholders to maintain a co-ordinated research agenda, are essential for successful CER in rheumatology.


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  1. Department of Pediatrics and The James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Centre, Division of Rheumatology, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.

    • Esi Morgan DeWitt &
    • Hermine I. Brunner


E. M. DeWitt and H. I. Brunner contributed substantially to researching data for the article, discussion of content, writing the article and to reviewing the manuscript before submission.

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The authors declare no competing interests.

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  • Esi Morgan DeWitt

    Esi Morgan DeWitt is currently an Associate Professor at the Department of Pediatrics at Cincinnati Children's Hospital Medical Center, USA. Dr Morgan DeWitt received her MD from Washington University School of Medicine, St Louis, MO, USA, and completed her residency at the Children's Hospital of Philadelphia, PA, USA, where she also pursued a fellowship in rheumatology and a Master of Science in Clinical Epidemiology. Dr Morgan DeWitt's clinical and research interests include patient reported outcomes measure development, quality improvement, health services research, economic evaluations, comparative effectiveness and childhood rheumatic diseases. She is also a leader for the Pediatric Rheumatology Care and Outcomes Improvement Network.

  • Hermine I. Brunner

    Hermine Brunner received her MD from Ludwig Maximilan University, Munich, Germany, and completed her residency at the University of Chicago, USA. She then pursued fellowships in pediatric rheumatology and also completed a Masters degree in Clinical Epidemiology. Dr Brunner currently works in the department of Pediatrics at Cincinnati Children's Hospital Medical Center, USA. Dr Brunner is the scientific director of the Pediatric Rheumatology Collaborative Study Group and she is a steering committee member of the Childhood Arthritis and Rheumatology Research Alliance. Her clinical and research interests include health-related quality of life, outcome research, lupus, economic analyses, HRQOL, measurement development.

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