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EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update
- Source :
- Annals of the Rheumatic Diseases, Annals of the Rheumatic Diseases, BMJ Publishing Group, 2017, 76 (6), pp.960-977. 〈10.1136/annrheumdis-2016-210715〉, Annals of the Rheumatic Diseases, BMJ Publishing Group, 2017, 76 (6), pp.960-977. ⟨10.1136/annrheumdis-2016-210715⟩, Annals of the Rheumatic Diseases, 2017, 76 (6), pp.960-977. ⟨10.1136/annrheumdis-2016-210715⟩, Annals of the Rheumatic Diseases, 76(6), 960-977, Annals of the Rheumatic Diseases, 76(6), 960-977. BMJ Publishing Group, Annals of the Rheumatic Diseases, Vol. 76, No 6 (2017) pp. 960-977, Smolen, J S, Landewé, R, Bijlsma, J, Burmester, G, Chatzidionysiou, K, Dougados, M, Nam, J, Ramiro, S, Voshaar, M, Van Vollenhoven, R, Aletaha, D, Aringer, M, Boers, M, Buckley, C D, Buttgereit, F, Bykerk, V, Cardiel, M, Combe, B, Cutolo, M, Van Eijk-Hustings, Y, Emery, P, Finckh, A, Gabay, C, Gomez-Reino, J, Gossec, L, Gottenberg, J E, Hazes, J M W, Huizinga, T, Jani, M, Karateev, D, Kouloumas, M, Kvien, T, Li, Z, Mariette, X, McInnes, I, Mysler, E, Nash, P, Pavelka, K, Poór, G, Richez, C, Van Riel, P, Rubbert-Roth, A, Saag, K, Da Silva, J, Stamm, T, Takeuchi, T, Westhovens, R, De Wit, M & Van Der Heijde, D 2017, ' EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs : 2016 update ', Annals of the Rheumatic Diseases, vol. 76, no. 6, pp. 960-977 . https://doi.org/10.1136/annrheumdis-2016-210715, Annals of the Rheumatic Diseases, 76, 6, pp. 960-977, Annals of the Rheumatic Diseases, 76, 960-977, Smolen, J S, Landewe, R, Bijlsma, J W J, Burmester, G R, Chatzidionysiou, K, Combe, B, Dougados, M, Nam, J L, Ramiro, S, Scholte, M, van Vollenhoven, R F, Aletaha, D, Aringer, M, Boers, M, Buckley, C, Bykerk, V, Buttgereit, F, Cardiel, M, Cutolo, M, van Eijk-Hustings, Y, Emery, P, Finckh, A, Gabay, C, Gómez-Reino, J J, Gossec, L, Gottenberg, J-E, Hazes, M, Huizinga, T, Jani, M, Karateev, D, Kouloumas, M, Kvien, T K, Li, Z, Mariette, X, McInnes, I B, Mysler, E, Nash, P, Pavelka, K, Poor, G, Richez, C, van Riel, P, Rubbert-Roth, A, Saag, K, Da Silva, J, Stamm, T, Takeuchi, T, Westhovens, R, de Wit, M & van der Heijde, D 2017, ' EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 Update ', Annals of the rheumatic diseases, vol. 76, no. 6, pp. 960-977 . https://doi.org/10.1136/annrheumdis-2016-210715
- Publication Year :
- 2017
-
Abstract
- International audience; 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.
- Subjects :
- Glucocorticoids/therapeutic use
Time Factors
Protein Kinase Inhibitors/therapeutic use
medicine.medical_treatment
Antirheumatic Agents/therapeutic use
DMARDs (biologic)
PLACEBO-CONTROLLED TRIAL
law.invention
ACUTE-PHASE REACTANTS
Arthritis, Rheumatoid
0302 clinical medicine
Randomized controlled trial
law
Immunology and Allergy
030212 general & internal medicine
Janus Kinases/antagonists & inhibitors
Certolizumab pegol
INTERLEUKIN-6 RECEPTOR INHIBITION
skin and connective tissue diseases
ddc:616
Drug Substitution
DOSE GLUCOCORTICOID THERAPY
Antibodies, Monoclonal
ADALIMUMAB PLUS METHOTREXATE
RANDOMIZED CONTROLLED-TRIAL
3. Good health
Antirheumatic Agents
TREAT-TO-TARGET
[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
Arthritis, Rheumatoid/drug therapy
Rheumatoid arthritis
Drug Therapy, Combination
DMARDs (synthetic)
medicine.drug
musculoskeletal diseases
medicine.medical_specialty
Methotrexate/therapeutic use
Immunology
Antibodies, Monoclonal/therapeutic use
Rheumatoid Arthritis
General Biochemistry, Genetics and Molecular Biology
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
[ SDV.MHEP.RSOA ] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
03 medical and health sciences
Rheumatology
RAPID RADIOGRAPHIC PROGRESSION
medicine
Humans
Disease-modifying antirheumatic drug
Intensive care medicine
Disease Activity
Glucocorticoids
Protein Kinase Inhibitors
Janus Kinases
STANDARDIZED OPERATING PROCEDURES
030203 arthritis & rheumatology
business.industry
Tumor Necrosis Factor-alpha
Tumor Necrosis Factor-alpha/antagonists & inhibitors
Abatacept
Evidence-based medicine
medicine.disease
Treatment
Methotrexate
Patient Participation
business
Rheumatism
CARDIOVASCULAR RISK-MANAGEMENT
Subjects
Details
- Language :
- English
- ISSN :
- 00034967 and 14682060
- Database :
- OpenAIRE
- Journal :
- Annals of the Rheumatic Diseases, Annals of the Rheumatic Diseases, BMJ Publishing Group, 2017, 76 (6), pp.960-977. 〈10.1136/annrheumdis-2016-210715〉, Annals of the Rheumatic Diseases, BMJ Publishing Group, 2017, 76 (6), pp.960-977. ⟨10.1136/annrheumdis-2016-210715⟩, Annals of the Rheumatic Diseases, 2017, 76 (6), pp.960-977. ⟨10.1136/annrheumdis-2016-210715⟩, Annals of the Rheumatic Diseases, 76(6), 960-977, Annals of the Rheumatic Diseases, 76(6), 960-977. BMJ Publishing Group, Annals of the Rheumatic Diseases, Vol. 76, No 6 (2017) pp. 960-977, Smolen, J S, Landewé, R, Bijlsma, J, Burmester, G, Chatzidionysiou, K, Dougados, M, Nam, J, Ramiro, S, Voshaar, M, Van Vollenhoven, R, Aletaha, D, Aringer, M, Boers, M, Buckley, C D, Buttgereit, F, Bykerk, V, Cardiel, M, Combe, B, Cutolo, M, Van Eijk-Hustings, Y, Emery, P, Finckh, A, Gabay, C, Gomez-Reino, J, Gossec, L, Gottenberg, J E, Hazes, J M W, Huizinga, T, Jani, M, Karateev, D, Kouloumas, M, Kvien, T, Li, Z, Mariette, X, McInnes, I, Mysler, E, Nash, P, Pavelka, K, Poór, G, Richez, C, Van Riel, P, Rubbert-Roth, A, Saag, K, Da Silva, J, Stamm, T, Takeuchi, T, Westhovens, R, De Wit, M & Van Der Heijde, D 2017, ' EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs : 2016 update ', Annals of the Rheumatic Diseases, vol. 76, no. 6, pp. 960-977 . https://doi.org/10.1136/annrheumdis-2016-210715, Annals of the Rheumatic Diseases, 76, 6, pp. 960-977, Annals of the Rheumatic Diseases, 76, 960-977, Smolen, J S, Landewe, R, Bijlsma, J W J, Burmester, G R, Chatzidionysiou, K, Combe, B, Dougados, M, Nam, J L, Ramiro, S, Scholte, M, van Vollenhoven, R F, Aletaha, D, Aringer, M, Boers, M, Buckley, C, Bykerk, V, Buttgereit, F, Cardiel, M, Cutolo, M, van Eijk-Hustings, Y, Emery, P, Finckh, A, Gabay, C, Gómez-Reino, J J, Gossec, L, Gottenberg, J-E, Hazes, M, Huizinga, T, Jani, M, Karateev, D, Kouloumas, M, Kvien, T K, Li, Z, Mariette, X, McInnes, I B, Mysler, E, Nash, P, Pavelka, K, Poor, G, Richez, C, van Riel, P, Rubbert-Roth, A, Saag, K, Da Silva, J, Stamm, T, Takeuchi, T, Westhovens, R, de Wit, M & van der Heijde, D 2017, ' EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 Update ', Annals of the rheumatic diseases, vol. 76, no. 6, pp. 960-977 . https://doi.org/10.1136/annrheumdis-2016-210715
- Accession number :
- edsair.doi.dedup.....ddef2631ace40173b074facbe250fb47