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

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

doi:10.1136/annrheumdis-2019-216655

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

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Josef S Smolen

Function : Author

Medizinische Universität Wien = Medical University of Vienna

Robert B M Landewé

Function : Author

Academic Medical Center - Academisch Medisch Centrum [Amsterdam]

Johannes W J Bijlsma

Function : Author

Gerd R Burmester

Function : Author

Maxime Dougados

Function : Author

Hôpital Cochin [AP-HP]

Andreas Kerschbaumer

Function : Author

Medizinische Universität Wien = Medical University of Vienna

Iain B Mcinnes

Function : Author

Alexandre Sepriano

Function : Author

Leiden University Medical Center

Ronald F Van Vollenhoven

Function : Author

Maarten De Wit

Function : Author

Daniel Aletaha

Function : Author

Medizinische Universität Wien = Medical University of Vienna

Martin Aringer

Function : Author

John Askling

Function : Author

Alejandro Balsa

Function : Author

Maarten Boers

Function : Author

VU University Medical Center [Amsterdam]

Alfons A Den Broeder

Function : Author

Maya H Buch

Function : Author

University of Manchester [Manchester]

Frank Buttgereit

Function : Author

Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]

Roberto Caporali

Function : Author

Università degli Studi di Milano = University of Milan

Mario Humberto Cardiel

Function : Author

Diederik de Cock

Function : Author

Catalin Codreanu

Function : Author

University of Medicine and Pharmacy “Carol Davila” Bucharest

Maurizio Cutolo

Function : Author

Università degli studi di Genova = University of Genoa

Christopher John Edwards

Function : Author

Yvonne Van Eijk-Hustings

Function : Author

Paul Emery

Function : Author

University of Leeds

Axel Finckh

Function : Author

Geneva University Hospital

Laure Gossec

Function : Author

Institut Pierre Louis d'Epidémiologie et de Santé Publique

CHU Pitié-Salpêtrière [AP-HP]

Jacques-Eric Gottenberg

Function : Author

Immuno-Rhumatologie Moléculaire

Les Hôpitaux Universitaires de Strasbourg (HUS)

Merete Lund Hetland

Function : Author

Tom W J Huizinga

Function : Author

Marios Koloumas

Function : Author

Zhanguo Li

Function : Author

Xavier Mariette

Function : Author

Hôpital Bicêtre

Université Paris-Sud - Paris 11

Ulf Müller-Ladner

Function : Author

Justus-Liebig-Universität Gießen = Justus Liebig University

Eduardo F Mysler

Function : Author

Jose a P Da Silva

Function : Author

Gyula Poór

Function : Author

Janet E Pope

Function : Author

Andrea Rubbert-Roth

Function : Author

Brustzentrum Kantonsspital St. Gallen

Adeline Ruyssen-Witrand

Function : Author

Université Toulouse III - Paul Sabatier

Kenneth G Saag

Function : Author

Anja Strangfeld

Function : Author

Deutsches Rheuma-ForschungsZentrum

Tsutomu Takeuchi

Function : Author

Keio University School of Medicine [Tokyo, Japan]

Marieke Voshaar

Function : Author

University of Twente

René Westhovens

Function : Author

Catholic University of Leuven = Katholieke Universiteit Leuven

Désirée van Der Heijde

Function : Author

Leiden University Medical Center

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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Life Sciences [q-bio]

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Submitted on : Monday, December 12, 2022-4:41:00 PM

Last modification on : Thursday, November 23, 2023-2:44:05 PM

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hal-03895158 , version 1 (12-12-2022)

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HAL Id : hal-03895158 , version 1
DOI : 10.1136/annrheumdis-2019-216655

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

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