TY - JOUR
T1 - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs
T2 - 2019 update
AU - Smolen, Josef S.
AU - Landewe, Robert B. M.
AU - Bijlsma, Johannes W. J.
AU - Burmester, Gerd R.
AU - Dougados, Maxime
AU - Kerschbaumer, Andreas
AU - McInnes, Iain B.
AU - Sepriano, Alexandre
AU - van Vollenhoven, Ronald F.
AU - de Wit, Maarten
AU - Aletaha, Daniel
AU - Aringer, Martin
AU - Askling, John
AU - Balsa, Alejandro
AU - Boers, Maarten
AU - den Broeder, Alfons A.
AU - Buch, Maya H.
AU - Buttgereit, Frank
AU - Caporali, Roberto
AU - Cardiel, Mario Humberto
AU - De Cock, Diederik
AU - Codreanu, Catalin
AU - Cutolo, Maurizio
AU - Edwards, Christopher John
AU - van Eijk-Hustings, Yvonne
AU - Emery, Paul
AU - Finckh, Axel
AU - Gossec, Laure
AU - Gottenberg, Jacques-Eric
AU - Hetland, Merete Lund
AU - Huizinga, Tom W. J.
AU - Koloumas, Marios
AU - Li, Zhanguo
AU - Mariette, Xavier
AU - Mueller-Ladner, Ulf
AU - Mysler, Eduardo F.
AU - da Silva, Jose A. P.
AU - Poor, Gyula
AU - Pope, Janet E.
AU - Rubbert-Roth, Andrea
AU - Ruyssen-Witrand, Adeline
AU - Saag, Kenneth G.
AU - Strangfeld, Anja
AU - Takeuchi, Tsutomu
AU - Voshaar, Marieke
AU - Westhovens, Rene
AU - van der Heijde, Desiree
PY - 2020/6
Y1 - 2020/6
N2 - Objectives To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field.Methods An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items.Results The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high.Conclusions These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.
AB - Objectives To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field.Methods An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items.Results The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high.Conclusions These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.
KW - TREAT-TO-TARGET
KW - INTERLEUKIN-6 RECEPTOR INHIBITION
KW - CONSENSUS-BASED RECOMMENDATIONS
KW - RAPID RADIOGRAPHIC PROGRESSION
KW - DOSE GLUCOCORTICOID THERAPY
KW - TREATMENT STRATEGIES
KW - REMISSION INDUCTION
KW - CERTOLIZUMAB PEGOL
KW - RHEUMATOLOGY/EUROPEAN LEAGUE
KW - AMERICAN-COLLEGE
U2 - 10.1136/annrheumdis-2019-216655
DO - 10.1136/annrheumdis-2019-216655
M3 - Article
C2 - 31969328
VL - 79
SP - 685
EP - 699
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
SN - 0003-4967
IS - 6
ER -