PT  - JOURNAL ARTICLE
AU  - Josef S Smolen
AU  - Robert B M Landewé
AU  - Johannes W J Bijlsma
AU  - Gerd R Burmester
AU  - Maxime Dougados
AU  - Andreas Kerschbaumer
AU  - Iain B McInnes
AU  - Alexandre Sepriano
AU  - Ronald F van Vollenhoven
AU  - Maarten de Wit
AU  - Daniel Aletaha
AU  - Martin Aringer
AU  - John Askling
AU  - Alejandro Balsa
AU  - Maarten Boers
AU  - Alfons A den Broeder
AU  - Maya H Buch
AU  - Frank Buttgereit
AU  - Roberto Caporali
AU  - Mario Humberto Cardiel
AU  - Diederik De Cock
AU  - Catalin Codreanu
AU  - Maurizio Cutolo
AU  - Christopher John Edwards
AU  - Yvonne van Eijk-Hustings
AU  - Paul Emery
AU  - Axel Finckh
AU  - Laure Gossec
AU  - Jacques-Eric Gottenberg
AU  - Merete Lund Hetland
AU  - Tom W J Huizinga
AU  - Marios Koloumas
AU  - Zhanguo Li
AU  - Xavier Mariette
AU  - Ulf Müller-Ladner
AU  - Eduardo F Mysler
AU  - Jose A P da Silva
AU  - Gyula Poór
AU  - Janet E Pope
AU  - Andrea Rubbert-Roth
AU  - Adeline Ruyssen-Witrand
AU  - Kenneth G Saag
AU  - Anja Strangfeld
AU  - Tsutomu Takeuchi
AU  - Marieke Voshaar
AU  - René Westhovens
AU  - Désirée van der Heijde
TI  - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update
AID  - 10.1136/annrheumdis-2019-216655
DP  - 2020 Jun 01
TA  - Annals of the Rheumatic Diseases
PG  - 685--699
VI  - 79
IP  - 6
4099  - http://ard.bmj.com/content/79/6/685.short
4100  - http://ard.bmj.com/content/79/6/685.full
SO  - Ann Rheum Dis2020 Jun 01; 79
AB  - Objectives To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field.Methods An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items.Results The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high.Conclusions These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.