EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update
Open Access
- 25 October 2013
- journal article
- review article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 73 (3), 492-509
- https://doi.org/10.1136/annrheumdis-2013-204573
Abstract
In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches. The evidence presented was discussed and summarised by the experts in the course of a consensus finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) were determined. Fourteen recommendations were developed (instead of 15 in 2010). Some of the 2010 recommendations were deleted, and others were amended or split. The recommendations cover general aspects, such as attainment of remission or low disease activity using a treat-to-target approach, and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting DMARD therapy using a conventional sDMARD (csDMARD) strategy in combination with glucocorticoids, followed by the addition of a bDMARD or another csDMARD strategy (after stratification by presence or absence of adverse risk factors) if the treatment target is not reached within 6 months (or improvement not seen at 3 months). Tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, biosimilars), abatacept, tocilizumab and, under certain circumstances, rituximab are essentially considered to have similar efficacy and safety. If the first bDMARD strategy fails, any other bDMARD may be used. The recommendations also address tofacitinib as a targeted sDMARD (tsDMARD), which is recommended, where licensed, after use of at least one bDMARD. Biosimilars are also addressed. These recommendations are intended to inform rheumatologists, patients, national rheumatology societies and other stakeholders about EULAR's most recent consensus on the management of RA with sDMARDs, glucocorticoids and bDMARDs. They are based on evidence and expert opinion and intended to improve outcome in patients with RA.Keywords
This publication has 154 references indexed in Scilit:
- The new 2012 German recommendations for treating rheumatoid arthritisZeitschrift für Rheumatologie, 2013
- Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010The Lancet, 2013
- Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010The Lancet, 2013
- Head‐to‐head comparison of subcutaneous abatacept versus adalimumab for rheumatoid arthritis: Findings of a phase IIIb, multinational, prospective, randomized studyArthritis & Rheumatism, 2012
- Factors Associated With the Initiation of Disease-Modifying Antirheumatic Drugs in Newly Diagnosed Rheumatoid Arthritis: A Retrospective Claims Database StudyClinical Therapeutics, 2012
- Management of rheumatoid arthritis: consensus recommendations from the Hong Kong Society of RheumatologyClinical Rheumatology, 2010
- A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritisRheumatology, 2009
- Study of active controlled monotherapy used for rheumatoid arthritis, an IL-6 inhibitor (SAMURAI): evidence of clinical and radiographic benefit from an x ray reader-blinded randomised controlled trial of tocilizumabAnnals Of The Rheumatic Diseases, 2007
- Low‐dose prednisolone in addition to the initial disease‐modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: A two‐year randomized trialArthritis & Rheumatism, 2005
- COBRA combination therapy in patients with early rheumatoid arthritis: Long‐term structural benefits of a brief interventionArthritis & Rheumatism, 2002