TY - JOUR T1 - Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 1113 LP - 1136 DO - 10.1136/annrheumdis-2016-210713 VL - 76 IS - 6 AU - Jackie L Nam AU - Kaoru Takase-Minegishi AU - Sofia Ramiro AU - Katerina Chatzidionysiou AU - Josef S Smolen AU - Désirée van der Heijde AU - Johannes W Bijlsma AU - Gerd R Burmester AU - Maxime Dougados AU - Marieke Scholte-Voshaar AU - Ronald van Vollenhoven AU - Robert Landewé Y1 - 2017/06/01 UR - http://ard.bmj.com/content/76/6/1113.abstract N2 - Objectives To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) to inform European League Against Rheumatism (EULAR) Task Force treatment recommendations.Methods MEDLINE, EMBASE and Cochrane databases were searched for phase III or IV (or phase II, if these studies were lacking) randomised controlled trials (RCTs) published between January 2013 and February 2016. Abstracts from the American College of Rheumatology and EULAR conferences were obtained.Results The RCTs confirmed greater efficacy with a bDMARD+conventional synthetic DMARD (csDMARD) versus a csDMARDs alone (level 1A evidence). Using a treat-to-target strategy approach, commencing and escalating csDMARD therapy and adding a bDMARD in cases of non-response, is an effective approach (1B). If a bDMARD had failed, improvements in clinical response were seen on switching to another bDMARD (1A), but no clear advantage was seen for switching to an agent with another mode of action. Maintenance of clinical response in patients in remission or low disease activity was best when continuing rather than stopping a bDMARD, but bDMARD dose reduction or ‘spacing’ was possible, with a substantial proportion of patients achieving bDMARD-free remission (2B). RCTs have also demonstrated efficacy of several new bDMARDs and biosimilar DMARDs (1B).Conclusions This systematic literature review consistently confirmed the previously reported efficacy of bDMARDs in RA and provided additional information on bDMARD switching and dose reduction. ER -