EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

Josef S. Smolen; Robert Landewe; Ferdinand C. Breedveld; Maxime Dougados; Paul Emery; Cecile Gaujoux-Viala; Simone Gorter; Rachel Knevel; Jackie Nam; Monika Schoels; Daniel Aletaha; Maya Buch; Laure Gossec; Tom W J Huizinga; Johannes W J Bijlsma; Gerd Burmester; Bernard Combe; Maurizio Cutolo; Cem Gabay; Juan Gomez-Reino; Marios Kouloumas; Tore K. Kvien; Emilio Martin-Mola; Iain B. McInnes; Karel Pavelka; Piet van Riel; Marieke Scholte-Voshaar; David L. Scott; Tuulikki Sokka; Guido Valesini; Ronald F. van Vollenhoven; Kevin L. Winthrop; John Q. Wong; Angela Zink; Desiree van der Heijde

doi:10.1136/ard.2009.126532

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

Josef S. Smolen^*, Robert Landewe, Ferdinand C. Breedveld, Maxime Dougados, Paul Emery, Cecile Gaujoux-Viala, Simone Gorter, Rachel Knevel, Jackie Nam, Monika Schoels, Daniel Aletaha, Maya Buch, Laure Gossec, Tom W J Huizinga, Johannes W J Bijlsma, Gerd Burmester, Bernard Combe, Maurizio Cutolo, Cem Gabay, Juan Gomez-ReinoMarios Kouloumas, Tore K. Kvien, Emilio Martin-Mola, Iain B. McInnes, Karel Pavelka, Piet van Riel, Marieke Scholte-Voshaar, David L. Scott, Tuulikki Sokka, Guido Valesini, Ronald F. van Vollenhoven, Kevin L. Winthrop, John Q. Wong, Angela Zink, Desiree van der Heijde

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-a-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.

Original language	English
Pages (from-to)	964-975
Journal	Annals of the Rheumatic Diseases
Volume	69
Issue number	6
DOIs	https://doi.org/10.1136/ard.2009.126532
Publication status	Published - Jun 2010

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10.1136/ard.2009.126532

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Smolen, J. S., Landewe, R., Breedveld, F. C., Dougados, M., Emery, P., Gaujoux-Viala, C., Gorter, S., Knevel, R., Nam, J., Schoels, M., Aletaha, D., Buch, M., Gossec, L., Huizinga, T. W. J., Bijlsma, J. W. J., Burmester, G., Combe, B., Cutolo, M., Gabay, C., ... van der Heijde, D. (2010). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Annals of the Rheumatic Diseases, 69(6), 964-975. https://doi.org/10.1136/ard.2009.126532

@article{b499d60bffdd439ea1d53e5c31309ded,

title = "EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs",

abstract = "Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-a-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.",

author = "Smolen, {Josef S.} and Robert Landewe and Breedveld, {Ferdinand C.} and Maxime Dougados and Paul Emery and Cecile Gaujoux-Viala and Simone Gorter and Rachel Knevel and Jackie Nam and Monika Schoels and Daniel Aletaha and Maya Buch and Laure Gossec and Huizinga, {Tom W J} and Bijlsma, {Johannes W J} and Gerd Burmester and Bernard Combe and Maurizio Cutolo and Cem Gabay and Juan Gomez-Reino and Marios Kouloumas and Kvien, {Tore K.} and Emilio Martin-Mola and McInnes, {Iain B.} and Karel Pavelka and {van Riel}, Piet and Marieke Scholte-Voshaar and Scott, {David L.} and Tuulikki Sokka and Guido Valesini and {van Vollenhoven}, {Ronald F.} and Winthrop, {Kevin L.} and Wong, {John Q.} and Angela Zink and {van der Heijde}, Desiree",

year = "2010",

month = jun,

doi = "10.1136/ard.2009.126532",

language = "English",

volume = "69",

pages = "964--975",

journal = "Annals of the Rheumatic Diseases",

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Smolen, JS, Landewe, R, Breedveld, FC, Dougados, M, Emery, P, Gaujoux-Viala, C, Gorter, S, Knevel, R, Nam, J, Schoels, M, Aletaha, D, Buch, M, Gossec, L, Huizinga, TWJ, Bijlsma, JWJ, Burmester, G, Combe, B, Cutolo, M, Gabay, C, Gomez-Reino, J, Kouloumas, M, Kvien, TK, Martin-Mola, E, McInnes, IB, Pavelka, K, van Riel, P, Scholte-Voshaar, M, Scott, DL, Sokka, T, Valesini, G, van Vollenhoven, RF, Winthrop, KL, Wong, JQ, Zink, A & van der Heijde, D 2010, 'EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs', Annals of the Rheumatic Diseases, vol. 69, no. 6, pp. 964-975. https://doi.org/10.1136/ard.2009.126532

TY - JOUR

T1 - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

AU - Smolen, Josef S.

AU - Landewe, Robert

AU - Breedveld, Ferdinand C.

AU - Dougados, Maxime

AU - Emery, Paul

AU - Gaujoux-Viala, Cecile

AU - Gorter, Simone

AU - Knevel, Rachel

AU - Nam, Jackie

AU - Schoels, Monika

AU - Aletaha, Daniel

AU - Buch, Maya

AU - Gossec, Laure

AU - Huizinga, Tom W J

AU - Bijlsma, Johannes W J

AU - Burmester, Gerd

AU - Combe, Bernard

AU - Cutolo, Maurizio

AU - Gabay, Cem

AU - Gomez-Reino, Juan

AU - Kouloumas, Marios

AU - Kvien, Tore K.

AU - Martin-Mola, Emilio

AU - McInnes, Iain B.

AU - Pavelka, Karel

AU - van Riel, Piet

AU - Scholte-Voshaar, Marieke

AU - Scott, David L.

AU - Sokka, Tuulikki

AU - Valesini, Guido

AU - van Vollenhoven, Ronald F.

AU - Winthrop, Kevin L.

AU - Wong, John Q.

AU - Zink, Angela

AU - van der Heijde, Desiree

PY - 2010/6

Y1 - 2010/6

N2 - Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-a-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.

AB - Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-a-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.

U2 - 10.1136/ard.2009.126532

DO - 10.1136/ard.2009.126532

M3 - Article

C2 - 20444750

SN - 0003-4967

VL - 69

SP - 964

EP - 975

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 6

ER -