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 Josef S Smolen
A1 Robert B M Landewé
A1 Johannes W J Bijlsma
A1 Gerd R Burmester
A1 Maxime Dougados
A1 Andreas Kerschbaumer
A1 Iain B McInnes
A1 Alexandre Sepriano
A1 Ronald F van Vollenhoven
A1 Maarten de Wit
A1 Daniel Aletaha
A1 Martin Aringer
A1 John Askling
A1 Alejandro Balsa
A1 Maarten Boers
A1 Alfons A den Broeder
A1 Maya H Buch
A1 Frank Buttgereit
A1 Roberto Caporali
A1 Mario Humberto Cardiel
A1 Diederik De Cock
A1 Catalin Codreanu
A1 Maurizio Cutolo
A1 Christopher John Edwards
A1 Yvonne van Eijk-Hustings
A1 Paul Emery
A1 Axel Finckh
A1 Laure Gossec
A1 Jacques-Eric Gottenberg
A1 Merete Lund Hetland
A1 Tom W J Huizinga
A1 Marios Koloumas
A1 Zhanguo Li
A1 Xavier Mariette
A1 Ulf Müller-Ladner
A1 Eduardo F Mysler
A1 Jose A P da Silva
A1 Gyula Poór
A1 Janet E Pope
A1 Andrea Rubbert-Roth
A1 Adeline Ruyssen-Witrand
A1 Kenneth G Saag
A1 Anja Strangfeld
A1 Tsutomu Takeuchi
A1 Marieke Voshaar
A1 René Westhovens
A1 Désirée van der Heijde
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.