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Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2012
  1. Daniel E Furst1,
  2. Edward Clark Keystone2,
  3. Alexander K So,
  4. Jürgen Braun3,
  5. Ferry C Breedveld4,
  6. Gerd R Burmester5,
  7. Fabrizio De Benedetti6,
  8. Thomas Dörner7,
  9. Paul Emery8,
  10. Roy Fleischmann9,
  11. Allan Gibofsky10,
  12. J R Kalden11,
  13. Arthur Kavanaugh12,
  14. Bruce Kirkham13,
  15. Philip Mease14,
  16. A Rubbert-Roth15,
  17. Joachim Sieper16,
  18. Nora G Singer17,
  19. Josef S Smolen18,19,
  20. Piet L C M Van Riel20,
  21. Michael H Weisman21,
  22. Kevin L Winthrop22
  1. 1Department of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA
  2. 2Department of Rheumatology, University of Toronto, Toronto, Canada
  3. 3Rheumazentrum Ruhrgebiet, Herne, Germany
  4. 4Leiden University Medical Centre, Leiden, The Netherlands
  5. 5Laboratorio di Reumatologia, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
  6. 6Department of Rheumatology and Clinical Immunology, Charite-University Medicine, Berlin, Germany
  7. 7Institut für Transfusionsmedizin, Klinische Hämostaseologie, Charite Universitätsmedizin Berlin, Berlin, Germany
  8. 8Section of Musculoskeletal Disease Biomedical Research Unit, Leeds Institute of Molecular Medicine and Teaching Hospitals Trust, University of Leeds, Leeds, UK
  9. 9University of Texas Southwestern Medical Center, Dallas, Texas, USA
  10. 10Rheumatology/Medicine Hospital for Special Surgery, New York, New York, USA
  11. 11Department of Rheumatology, University Erlangen-Nuremberg, Erlangen, Germany
  12. 12Department of Rheumatology/Allergy Immunology, University California San Diego, La Jolla, California, USA
  13. 13Rheumatology Department, Guys Hospital, London, UK
  14. 14Swedish Medical Center and University of Washington, Seattle, Washington, USA
  15. 15Department of Internal Medicine I, University of Cologne, Cologne, Germany
  16. 16Department of Medicine/Rheumatology, Charite Campus Benjamin Franklin, Berlin, Germany
  17. 17Division of Rheumatology, MetroHealth Medical Center/Case Western Reserve Society, Cleveland, Ohio, USA
  18. 182nd Department of Medicine, Krankenhaus Lainz, Vienna, Austria
  19. 19Department of Rheumatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria
  20. 20Department of Rheumatology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
  21. 21Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA
  22. 22Department of Infectious Diseases, Oregon Health and Science University, Portland, Oregon, USA
  1. Correspondence to Professor Daniel E Furst, David Geffen School of Medicine, UCLA—RM 32–59, 1000 Veteran Avenue, Los Angeles, CA 90025, USA; defurst{at}mednet.ucla.edu

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Introduction

As in previous years, the consensus group to consider the use of biological agents in the treatment of rheumatic diseases met during the 13th Annual Workshop on Advances in Targeted Therapies in March 2012. The group comprised rheumatologists from a number of universities among the continents of Europe, North America, South America, Australia and Asia.

Pharmaceutical industry support was obtained from a number of companies for the annual workshop itself, but these companies had no part in decisions about the specific programme or about the academic participants attending this conference. Representatives of the supporting sponsors participated in the initial working groups to supply factual information. The sponsors did not participate in the drafting of the consensus statement.

This consensus was prepared from the perspective of the treating physician.

In view of the new data for abatacept, B cell-specific agents, interleukin 1 (IL-1) antagonists, pegloticase, tocilizumab (TCZ) and tumour necrosis factor α blocking agents (TNFi), an update of the previous consensus statement is appropriate. To enable ease of updating, the 2011 (data from March 2010 to January 2011 updates are incorporated into the body of the consensus, while 2012 updates (February 2011 to January 2012) are separated and highlighted. The consensus statement is annotated to document the credibility of the data supporting it as much as possible. This annotation is that of Shekelle et al and is described in online supplementary appendix 1.1 We have modified the Shekelle annotation by designating all abstracts as ‘category D evidence’, whether they describe well-controlled trials or not, as details of the study were often not available in the abstracts. Further, the number of possible references has become so large that reviews are sometimes included. If they contain category A references, they will be referred to as category A evidence.

The 192 rheumatologists and …

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