EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update - Sorbonne Université Access content directly
Journal Articles Annals of the Rheumatic Diseases Year : 2020

EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update

Johannes W J Bijlsma
  • Function : Author
Gerd R Burmester
  • Function : Author
Iain B Mcinnes
  • Function : Author
Ronald F Van Vollenhoven
  • Function : Author
Maarten De Wit
  • Function : Author
Martin Aringer
  • Function : Author
John Askling
  • Function : Author
Alejandro Balsa
  • Function : Author
Alfons A Den Broeder
  • Function : Author
Mario Humberto Cardiel
  • Function : Author
Diederik de Cock
  • Function : Author
Christopher John Edwards
  • Function : Author
Yvonne Van Eijk-Hustings
  • Function : Author
Paul Emery
  • Function : Author
Merete Lund Hetland
  • Function : Author
Tom W J Huizinga
  • Function : Author
Marios Koloumas
  • Function : Author
Zhanguo Li
  • Function : Author
Eduardo F Mysler
  • Function : Author
Jose a P Da Silva
  • Function : Author
Gyula Poór
  • Function : Author
Janet E Pope
  • Function : Author
Kenneth G Saag
  • Function : Author

Abstract

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.
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hal-03895158 , version 1 (30-04-2024)

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Josef S Smolen, Robert B M Landewé, Johannes W J Bijlsma, Gerd R Burmester, Maxime Dougados, et al.. EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update. Annals of the Rheumatic Diseases, 2020, 79 (6), pp.685--699. ⟨10.1136/annrheumdis-2019-216655⟩. ⟨hal-03895158⟩
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