RT Journal Article
SR Electronic
T1 EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 960
OP 977
DO 10.1136/annrheumdis-2016-210715
VO 76
IS 6
A1 Smolen, Josef S
A1 Landewé, Robert
A1 Bijlsma, Johannes
A1 Burmester, Gerd
A1 Chatzidionysiou, Katerina
A1 Dougados, Maxime
A1 Nam, Jackie
A1 Ramiro, Sofia
A1 Voshaar, Marieke
A1 van Vollenhoven, Ronald
A1 Aletaha, Daniel
A1 Aringer, Martin
A1 Boers, Maarten
A1 Buckley, Chris D
A1 Buttgereit, Frank
A1 Bykerk, Vivian
A1 Cardiel, Mario
A1 Combe, Bernard
A1 Cutolo, Maurizio
A1 van Eijk-Hustings, Yvonne
A1 Emery, Paul
A1 Finckh, Axel
A1 Gabay, Cem
A1 Gomez-Reino, Juan
A1 Gossec, Laure
A1 Gottenberg, Jacques-Eric
A1 Hazes, Johanna M W
A1 Huizinga, Tom
A1 Jani, Meghna
A1 Karateev, Dmitry
A1 Kouloumas, Marios
A1 Kvien, Tore
A1 Li, Zhanguo
A1 Mariette, Xavier
A1 McInnes, Iain
A1 Mysler, Eduardo
A1 Nash, Peter
A1 Pavelka, Karel
A1 Poór, Gyula
A1 Richez, Christophe
A1 van Riel, Piet
A1 Rubbert-Roth, Andrea
A1 Saag, Kenneth
A1 da Silva, Jose
A1 Stamm, Tanja
A1 Takeuchi, Tsutomu
A1 Westhovens, René
A1 de Wit, Maarten
A1 van der Heijde, Désirée
YR 2017
UL http://ard.bmj.com/content/76/6/960.abstract
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.