TY - JOUR
T1 - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs
T2 - 2022 update
AU - Smolen, Josef S.
AU - Landewé, Robert B.M.
AU - Bergstra, Sytske Anne
AU - Kerschbaumer, Andreas
AU - Sepriano, Alexandre
AU - Aletaha, Daniel
AU - Caporali, Roberto
AU - Edwards, Christopher John
AU - Hyrich, Kimme L.
AU - Pope, Janet E.
AU - De Souza, Savia
AU - Stamm, Tanja A.
AU - Takeuchi, Tsutomu
AU - Verschueren, Patrick
AU - Winthrop, Kevin L.
AU - Balsa, Alejandro
AU - Bathon, Joan M.
AU - Buch, Maya H.
AU - Burmester, Gerd R.
AU - Buttgereit, Frank
AU - Cardiel, Mario Humberto
AU - Chatzidionysiou, Katerina
AU - Codreanu, Catalin
AU - Cutolo, Maurizio
AU - Den Broeder, Alfons A.
AU - El Aoufy, Khadija
AU - Finckh, Axel
AU - Fonseca, João Eurico
AU - Gottenberg, Jacques Eric
AU - Haavardsholm, Espen A.
AU - Iagnocco, Annamaria
AU - Lauper, Kim
AU - Li, Zhanguo
AU - McInnes, Iain B.
AU - Mysler, Eduardo F.
AU - Nash, Peter
AU - Poor, Gyula
AU - Ristic, Gorica G.
AU - Rivellese, Felice
AU - Rubbert-Roth, Andrea
AU - Schulze-Koops, Hendrik
AU - Stoilov, Nikolay
AU - Strangfeld, Anja
AU - Van Der Helm-Van Mil, Annette
AU - Van Duuren, Elsa
AU - Vliet Vlieland, Theodora P.M.
AU - Westhovens, René
AU - Van Der Heijde, Désirée
AU - Smolen, Josef S.
N1 - Funding Information:
This study was funded by European League Against Rheumatism.
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/11
Y1 - 2022/11
N2 - Objectives: To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field. Methods: An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item. Results: The task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3-6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations. Conclusions: These updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.
AB - Objectives: To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field. Methods: An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item. Results: The task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3-6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations. Conclusions: These updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.
KW - Antirheumatic Agents
KW - Arthritis, Rheumatoid
KW - Biological Therapy
UR - http://www.scopus.com/inward/record.url?scp=85143147170&partnerID=8YFLogxK
U2 - 10.1136/ard-2022-223356
DO - 10.1136/ard-2022-223356
M3 - Article
C2 - 36357155
AN - SCOPUS:85143147170
SN - 0003-4967
VL - 82
SP - 3
EP - 18
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 1
M1 - 223356
ER -