TY - JOUR
T1 - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs
T2 - 2016 update
AU - Smolen, Josef S.
AU - Landewe, Robert
AU - Bijlsma, Johannes
AU - Burmester, Gerd
AU - Chatzidionysiou, Katerina
AU - Dougados, Maxime
AU - Nam, Jackie
AU - Ramiro, Sofia
AU - Voshaar, Marieke
AU - van Vollenhoven, Ronald
AU - Aletaha, Daniel
AU - Aringer, Martin
AU - Boers, Maarten
AU - Buckley, Chris D.
AU - Buttgereit, Frank
AU - Bykerk, Vivian
AU - Cardiel, Mario
AU - Combe, Bernard
AU - Cutolo, Maurizio
AU - van Eijk-Hustings, Yvonne
AU - Emery, Paul
AU - Finckh, Axel
AU - Gabay, Cem
AU - Gomez-Reino, Juan
AU - Gossec, Laure
AU - Gottenberg, Jacques-Eric
AU - Hazes, Johanna M. W.
AU - Huizinga, Tom
AU - Jani, Meghna
AU - Karateev, Dmitry
AU - Kouloumas, Marios
AU - Kvien, Tore
AU - Li, Zhanguo
AU - Mariette, Xavier
AU - McInnes, Iain
AU - Mysler, Eduardo
AU - Nash, Peter
AU - Pavelka, Karel
AU - Poor, Gyula
AU - Richez, Christophe
AU - van Riel, Piet
AU - Rubbert-Roth, Andrea
AU - Saag, Kenneth
AU - da Silva, Jose
AU - Stamm, Tanja
AU - Takeuchi, Tsutomu
AU - Westhovens, Rene
AU - de Wit, Maarten
AU - van der Heijde, Desiree
PY - 2017/6
Y1 - 2017/6
N2 - Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.
AB - Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.
KW - ADALIMUMAB PLUS METHOTREXATE
KW - INTERLEUKIN-6 RECEPTOR INHIBITION
KW - RANDOMIZED CONTROLLED-TRIAL
KW - PLACEBO-CONTROLLED TRIAL
KW - TREAT-TO-TARGET
KW - STANDARDIZED OPERATING PROCEDURES
KW - RAPID RADIOGRAPHIC PROGRESSION
KW - CARDIOVASCULAR RISK-MANAGEMENT
KW - DOSE GLUCOCORTICOID THERAPY
KW - ACUTE-PHASE REACTANTS
U2 - 10.1136/annrheumdis-2016-210715
DO - 10.1136/annrheumdis-2016-210715
M3 - (Systematic) Review article
SN - 0003-4967
VL - 76
SP - 960
EP - 977
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 6
ER -