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Efficacy of glucocorticoids, conventional and targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis
  1. Katerina Chatzidionysiou1,
  2. Sharzad Emamikia1,
  3. Jackie Nam2,
  4. Sofia Ramiro3,
  5. Josef Smolen4,
  6. Désirée van der Heijde3,
  7. Maxime Dougados5,
  8. Johannes Bijlsma6,
  9. Gerd Burmester7,
  10. Marieke Scholte8,9,
  11. Ronald van Vollenhoven1,10,
  12. Robert Landewé10
  1. 1Karolinska Institute, Stockholm, Sweden
  2. 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  3. 3LUMC, Leiden, The Netherlands
  4. 4Medical University of Vienna, Vienna, Austria
  5. 5Paris Descartes University, Paris, France
  6. 6Utrecht University Medical Center, Utrecht, The Netherlands
  7. 7Charité University Hospital, Berlin, Germany
  8. 8Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
  9. 9EULAR Standing Committee of People with Arthritis/Rheumatism in Europe
  10. 10Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Katerina Chatzidionysiou, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Rheumatology Department, Karolinska University Hospital, The Karolinska Institute, Stockholm 171 76, Sweden; aikaterini.chatzidionysiou{at}


Objectives To perform a systematic literature review (SLR) informing the 2016 update of the recommendations for the management of rheumatoid arthritis (RA).

Methods An SLR for the period between 2013 and 2016 was undertaken to assess the efficacy of glucocorticoids (GCs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) (tofacitinib and baricitinib) in randomised clinical trials.

Results For GCs, four studies were included in the SLR. Patients without poor prognostic factors experienced benefit when GCs were added to methotrexate (MTX). Lower doses of GCs were similar to higher doses. For csDMARDs, two new studies comparing MTX monotherapy with combination csDMARD were included in the SLR. In the tREACH trial at the end of 12 months no difference between the groups in disease activity, functional ability and radiographic progression was seen, using principles of tight control (treat-to-target). In the CareRA trial, combination therapy with csDMARDs was not superior to MTX monotherapy and monotherapy was better tolerated.

For tsDMARDs, tofacitinib and baricitinib were shown to be more effective than placebo (MTX) in different patient populations.

Conclusions Addition of GCs to csDMARD therapy may be beneficial but the benefits should be balanced against the risk of toxicity. Under tight control conditions MTX monotherapy is not less effective than combination csDMARDs, but better tolerated. Tofacitinib and baricitinib are efficacious in patients with RA, including those with refractory disease.

  • Rheumatoid Arthritis
  • Treatment
  • Corticosteroids
  • DMARDs (synthetic)

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  • Handling editor Dr. Francis Berenbaum

  • Contributors All authors contributed and finally approved the current manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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