EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update.
- Smolen JS Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria josef.smolen@meduniwien.ac.at.
- Landewé RBM Amsterdam University Medical Center, Amsterdam, The Netherlands.
- Bijlsma JWJ Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
- Burmester GR Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany.
- Dougados M Rhumatologie B, Hopital Cochin, 27 rue du Fbg Saint-Jacques, Paris, France.
- Kerschbaumer A Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
- McInnes IB Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
- Sepriano A NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
- van Vollenhoven RF Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
- de Wit M EULAR Patient Research Partner; Department Medical Humanities, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- Aletaha D Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
- Aringer M Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany.
- Askling J Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
- Balsa A Servicio de Reumatologia Hospital Universitario La Paz, Instituto de Investigacion IdiPAZ, Madrid, Spain.
- Boers M Department of Epidemiology and Biostatistics and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- den Broeder AA Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
- Buch MH Division of Musculoskeletal and Dermatological Sciences, University of Manchester; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
- Buttgereit F Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany.
- Caporali R Department of Clinical Sciences and Community Health, University of Milan, and IRCCS S Matteo Foundation, Pavia, Italy.
- Cardiel MH Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán, Mexico.
- De Cock D Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
- Codreanu C Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania.
- Cutolo M Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine - University of Genoa, Genoa, Italy.
- Edwards CJ Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton, Southampton, UK.
- van Eijk-Hustings Y Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands.
- Emery P NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- Finckh A Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.
- Gossec L Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris and Pitié Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France.
- Gottenberg JE Strasbourg University Hospital and University of Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg, France.
- Hetland ML Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Huizinga TWJ Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
- Koloumas M European League Against Rheumatism, Zurich, Switzerland.
- Li Z Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China.
- Mariette X Université Paris-Sud, AP-HP, Université Paris-Saclay, Le Kremlin Bicêtre, France.
- Müller-Ladner U Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig University Giessen, Bad Nauheim, Germany.
- Mysler EF Organización Médica de Investigación, Buenos Aires, Argentina.
- da Silva JAP Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, and Coimbra Institute for Clinical and Biomedical Research (i-CRB), Faculty of Medicine of Coimbra, Coimbra, Portugal.
- Poór G National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary.
- Pope JE University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine, London, Ontario, Canada.
- Rubbert-Roth A Klinik für Rheumatologie, Kantonsspital St Gallen, St Gallen, Switzerland.
- Ruyssen-Witrand A UMR 1027, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France.
- Saag KG Department of Medicine, Division of Rheumatology, University of Alabama at Birmingham, Brmingham, Alabama, USA.
- Strangfeld A Programme Area Epidemiology, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany.
- Takeuchi T Keio University School of Medicine, Keio University Hospital, Tokyo, Japan.
- Voshaar M Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
- Westhovens R Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
- van der Heijde D Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
- 2020-01-24
Published in:
- Annals of the rheumatic diseases. - 2020
DMARDs (biologic)
DMARDs (synthetic)
economic evaluations
rheumatoid arthritis
treatment
Antirheumatic Agents
Arthritis, Rheumatoid
Biological Products
Consensus
Drug Therapy, Combination
Europe
Humans
Janus Kinase Inhibitors
Societies, Medical
Synthetic Drugs
Systematic Reviews as Topic
Tumor Necrosis Factor-alpha
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1136/annrheumdis-2019-216655
- PMID 31969328
- Persistent URL
- https://folia.unifr.ch/global/documents/76787
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