RT Journal Article
SR Electronic
T1 EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP annrheumdis-2013-204573
DO 10.1136/annrheumdis-2013-204573
A1 Josef S Smolen
A1 Robert Landewé
A1 Ferdinand C Breedveld
A1 Maya Buch
A1 Gerd Burmester
A1 Maxime Dougados
A1 Paul Emery
A1 Cécile Gaujoux-Viala
A1 Laure Gossec
A1 Jackie Nam
A1 Sofia Ramiro
A1 Kevin Winthrop
A1 Maarten de Wit
A1 Daniel Aletaha
A1 Neil Betteridge
A1 Johannes W J Bijlsma
A1 Maarten Boers
A1 Frank Buttgereit
A1 Bernard Combe
A1 Maurizio Cutolo
A1 Nemanja Damjanov
A1 Johanna M W Hazes
A1 Marios Kouloumas
A1 Tore K Kvien
A1 Xavier Mariette
A1 Karel Pavelka
A1 Piet L C M van Riel
A1 Andrea Rubbert-Roth
A1 Marieke Scholte-Voshaar
A1 David L Scott
A1 Tuulikki Sokka-Isler
A1 John B Wong
A1 Désirée van der Heijde
YR 2013
UL http://ard.bmj.com/content/early/2013/10/23/annrheumdis-2013-204573.abstract
AB In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches. The evidence presented was discussed and summarised by the experts in the course of a consensus finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) were determined. Fourteen recommendations were developed (instead of 15 in 2010). Some of the 2010 recommendations were deleted, and others were amended or split. The recommendations cover general aspects, such as attainment of remission or low disease activity using a treat-to-target approach, and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting DMARD therapy using a conventional sDMARD (csDMARD) strategy in combination with glucocorticoids, followed by the addition of a bDMARD or another csDMARD strategy (after stratification by presence or absence of adverse risk factors) if the treatment target is not reached within 6 months (or improvement not seen at 3 months). Tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, biosimilars), abatacept, tocilizumab and, under certain circumstances, rituximab are essentially considered to have similar efficacy and safety. If the first bDMARD strategy fails, any other bDMARD may be used. The recommendations also address tofacitinib as a targeted sDMARD (tsDMARD), which is recommended, where licensed, after use of at least one bDMARD. Biosimilars are also addressed. These recommendations are intended to inform rheumatologists, patients, national rheumatology societies and other stakeholders about EULAR's most recent consensus on the management of RA with sDMARDs, glucocorticoids and bDMARDs. They are based on evidence and expert opinion and intended to improve outcome in patients with RA.