RT Journal Article
SR Electronic
T1 EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 685
OP 699
DO 10.1136/annrheumdis-2019-216655
VO 79
IS 6
A1 Smolen, Josef S
A1 Landewé, Robert B M
A1 Bijlsma, Johannes W J
A1 Burmester, Gerd R
A1 Dougados, Maxime
A1 Kerschbaumer, Andreas
A1 McInnes, Iain B
A1 Sepriano, Alexandre
A1 van Vollenhoven, Ronald F
A1 de Wit, Maarten
A1 Aletaha, Daniel
A1 Aringer, Martin
A1 Askling, John
A1 Balsa, Alejandro
A1 Boers, Maarten
A1 den Broeder, Alfons A
A1 Buch, Maya H
A1 Buttgereit, Frank
A1 Caporali, Roberto
A1 Cardiel, Mario Humberto
A1 De Cock, Diederik
A1 Codreanu, Catalin
A1 Cutolo, Maurizio
A1 Edwards, Christopher John
A1 van Eijk-Hustings, Yvonne
A1 Emery, Paul
A1 Finckh, Axel
A1 Gossec, Laure
A1 Gottenberg, Jacques-Eric
A1 Hetland, Merete Lund
A1 Huizinga, Tom W J
A1 Koloumas, Marios
A1 Li, Zhanguo
A1 Mariette, Xavier
A1 Müller-Ladner, Ulf
A1 Mysler, Eduardo F
A1 da Silva, Jose A P
A1 Poór, Gyula
A1 Pope, Janet E
A1 Rubbert-Roth, Andrea
A1 Ruyssen-Witrand, Adeline
A1 Saag, Kenneth G
A1 Strangfeld, Anja
A1 Takeuchi, Tsutomu
A1 Voshaar, Marieke
A1 Westhovens, René
A1 van der Heijde, Désirée
YR 2020
UL http://ard.bmj.com/content/79/6/685.abstract
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.