Smolen, Josef S., Landewe, Robert, Bijlsma, Johannes, Burmester, Gerd, Chatzidionysiou, Katerina, Dougados, Maxime, Nam, Jackie, Ramiro, Sofia, Voshaar, Marieke, van Vollenhoven, Ronald, Aletaha, Daniel, Aringer, Martin ORCID: 0000-0003-4471-8375, Boers, Maarten, Buckley, Chris D., Buttgereit, Frank, Bykerk, Vivian, Cardiel, Mario, Combe, Bernard, Cutolo, Maurizio, van Eijk-Hustings, Yvonne, Emery, Paul, Finckh, Axel, Gabay, Cem, Gomez-Reino, Juan, Gossec, Laure, Gottenberg, Jacques-Eric, Hazes, Johanna M. W., Huizinga, Tom, Jani, Meghna ORCID: 0000-0002-1487-277X, Karateev, Dmitry, Kouloumas, Marios, Kvien, Tore, Li, Zhanguo, Mariette, Xavier, McInnes, Iain, Mysler, Eduardo, Nash, Peter ORCID: 0000-0002-2571-788X, Pavelka, Karel ORCID: 0000-0003-1952-8422, Poor, Gyula, Richez, Christophe, van Riel, Piet, Rubbert-Roth, Andrea, Saag, Kenneth, da Silva, Jose, Stamm, Tanja, Takeuchi, Tsutomu ORCID: 0000-0003-1111-8218, Westhovens, Rene, de Wit, Maarten and van der Heijde, Desiree ORCID: 0000-0002-5781-158X (2017). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann. Rheum. Dis., 76 (6). S. 960 - 978. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-2060

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Abstract

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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Smolen, Josef S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Landewe, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bijlsma, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Burmester, GerdUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chatzidionysiou, KaterinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dougados, MaximeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nam, JackieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ramiro, SofiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Voshaar, MariekeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Vollenhoven, RonaldUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aletaha, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aringer, MartinUNSPECIFIEDorcid.org/0000-0003-4471-8375UNSPECIFIED
Boers, MaartenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buckley, Chris D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buttgereit, FrankUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bykerk, VivianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cardiel, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Combe, BernardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cutolo, MaurizioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Eijk-Hustings, YvonneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Emery, PaulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Finckh, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gabay, CemUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gomez-Reino, JuanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gossec, LaureUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gottenberg, Jacques-EricUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hazes, Johanna M. W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huizinga, TomUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jani, MeghnaUNSPECIFIEDorcid.org/0000-0002-1487-277XUNSPECIFIED
Karateev, DmitryUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kouloumas, MariosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kvien, ToreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Li, ZhanguoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mariette, XavierUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
McInnes, IainUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mysler, EduardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nash, PeterUNSPECIFIEDorcid.org/0000-0002-2571-788XUNSPECIFIED
Pavelka, KarelUNSPECIFIEDorcid.org/0000-0003-1952-8422UNSPECIFIED
Poor, GyulaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Richez, ChristopheUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Riel, PietUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rubbert-Roth, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saag, KennethUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
da Silva, JoseUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stamm, TanjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Takeuchi, TsutomuUNSPECIFIEDorcid.org/0000-0003-1111-8218UNSPECIFIED
Westhovens, ReneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Wit, MaartenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van der Heijde, DesireeUNSPECIFIEDorcid.org/0000-0002-5781-158XUNSPECIFIED
URN: urn:nbn:de:hbz:38-229494
DOI: 10.1136/annrheumdis-2016-210715
Journal or Publication Title: Ann. Rheum. Dis.
Volume: 76
Number: 6
Page Range: S. 960 - 978
Date: 2017
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1468-2060
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ADALIMUMAB PLUS METHOTREXATE; INTERLEUKIN-6 RECEPTOR INHIBITION; TREAT-TO-TARGET; STANDARDIZED OPERATING PROCEDURES; RAPID RADIOGRAPHIC PROGRESSION; CARDIOVASCULAR RISK-MANAGEMENT; DOSE GLUCOCORTICOID THERAPY; PLACEBO-CONTROLLED TRIAL; DMARD-NAIVE PATIENTS; DOUBLE-BLINDMultiple languages
RheumatologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/22949

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