EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update
Language English Country United States Media print-electronic
Document type Journal Article, Review
Grant support
G1000417
Medical Research Council - United Kingdom
PubMed
28264816
DOI
10.1136/annrheumdis-2016-210715
PII: S0003-4967(24)02752-3
Knihovny.cz E-resources
- Keywords
- DMARDs (biologic), DMARDs (synthetic), Disease Activity, Rheumatoid Arthritis, Treatment,
- MeSH
- Antirheumatic Agents therapeutic use MeSH
- Time Factors MeSH
- Glucocorticoids therapeutic use MeSH
- Protein Kinase Inhibitors therapeutic use MeSH
- Janus Kinases antagonists & inhibitors MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Methotrexate therapeutic use MeSH
- Antibodies, Monoclonal therapeutic use MeSH
- Drug Substitution MeSH
- Arthritis, Rheumatoid drug therapy MeSH
- Tumor Necrosis Factor-alpha antagonists & inhibitors MeSH
- Patient Participation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Names of Substances
- Antirheumatic Agents MeSH
- Glucocorticoids MeSH
- Protein Kinase Inhibitors MeSH
- Janus Kinases MeSH
- Methotrexate MeSH
- Antibodies, Monoclonal MeSH
- Tumor Necrosis Factor-alpha MeSH
Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.
2nd Department of Medicine Hietzing Hospital Vienna Austria
5 A Nasonova Research Institute of Rheumatology Moscow Russian Federation
Amsterdam Rheumatology and Immunology Center Amsterdam The Netherlands
Centro de Investigación Clínica de Morelia SC Michoacán México
Cyprus League against Rheumatism Nicosia Cyprus
Department Medical Humanities VU Medical Centre Amsterdam The Netherlands
Department of Epidemiology and Biostatistics VU University Medical Center Amsterdam The Netherlands
Department of Medicine University of Queensland Queensland Australia
Department of Psychology Health and Technology University of Twente Enschede The Netherlands
Department of Rheumatology and Immunology Beijing University People's Hospital Beijing China
Department of Rheumatology Bernhoven Uden The Netherlands
Department of Rheumatology Diakonhjemmet Hospital Oslo Norway
Department of Rheumatology Leiden University Medical Center Leiden The Netherlands
Department of Rheumatology Sorbonne Universités Pitié Salpêtrière Hospital Paris France
Department of Rheumatology University Hospitals Leuven Leuven Belgium
Division of Rheumatology Department of Medicine 3 Medical University of Vienna Vienna Austria
Division of Rheumatology University Hospitals of Geneva Geneva Switzerland
Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
European League Against Rheumatism Zurich Switzerland
Fundación Ramón Dominguez Hospital Clinico Universitario Santiago Spain
Institute of Rheumatology and Clinic of Rheumatology Charles University Prague Czech Republic
Keio University School of Medicine Keio University Hospital Tokyo Japan
National Institute of Rheumatology and Physiotherapy Semmelweis University Budapest Hungary
Organización Médica de Investigación Buenos Aires Argentina
Research Laboratory and Division of Clinical Rheumatology University of Genoa Genoa Italy
Rheumatology Department Karolinska Institute Stockholm Sweden
Rheumatology Department Lapeyronie Hospital Montpellier University UMR 5535 Montpellier France
Rhumatologie B Hopital Cochin Paris France
References provided by Crossref.org
Opportunities and challenges in rheumatology research in Central Europe
