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

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 CardielDiederik 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

Department for Rheumatology and Spine Diseases

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.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	79
Issue number	6
Pages (from-to)	685-699
Number of pages	15
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2019-216655
Publication status	Published - Jun 2020

Keywords

Antirheumatic Agents/economics
Arthritis, Rheumatoid/drug therapy
Biological Products/economics
Consensus
Drug Therapy, Combination
Europe
Humans
Janus Kinase Inhibitors/therapeutic use
Societies, Medical
Synthetic Drugs/economics
Systematic Reviews as Topic
Tumor Necrosis Factor-alpha/antagonists & inhibitors

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10.1136/annrheumdis-2019-216655

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Smolen, J. S., Landewé, R. B. M., Bijlsma, J. W. J., Burmester, G. R., Dougados, M., Kerschbaumer, A., McInnes, I. B., Sepriano, A., van Vollenhoven, R. F., de Wit, M., Aletaha, D., Aringer, M., Askling, J., Balsa, A., Boers, M., den Broeder, A. A., Buch, M. H., Buttgereit, F., Caporali, R., ... van der Heijde, D. (2020). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases, 79(6), 685-699. https://doi.org/10.1136/annrheumdis-2019-216655

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. / Smolen, Josef S; Landewé, Robert B M; Bijlsma, Johannes W J et al.
In: Annals of the Rheumatic Diseases, Vol. 79, No. 6, 06.2020, p. 685-699.

Research output: Contribution to journal › Journal article › Research › peer-review

Smolen, JS, Landewé, RBM, Bijlsma, JWJ, Burmester, GR, Dougados, M, Kerschbaumer, A, McInnes, IB, Sepriano, A, van Vollenhoven, RF, de Wit, M, Aletaha, D, Aringer, M, Askling, J, Balsa, A, Boers, M, den Broeder, AA, Buch, MH, Buttgereit, F, Caporali, R, Cardiel, MH, De Cock, D, Codreanu, C, Cutolo, M, Edwards, CJ, van Eijk-Hustings, Y, Emery, P, Finckh, A, Gossec, L, Gottenberg, J-E, Hetland, ML, Huizinga, TWJ, Koloumas, M, Li, Z, Mariette, X, Müller-Ladner, U, Mysler, EF, da Silva, JAP, Poór, G, Pope, JE, Rubbert-Roth, A, Ruyssen-Witrand, A, Saag, KG, Strangfeld, A, Takeuchi, T, Voshaar, M, Westhovens, R & van der Heijde, D 2020, 'EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update', Annals of the Rheumatic Diseases, vol. 79, no. 6, pp. 685-699. https://doi.org/10.1136/annrheumdis-2019-216655

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title = "EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update",

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.",

keywords = "Antirheumatic Agents/economics, Arthritis, Rheumatoid/drug therapy, Biological Products/economics, Consensus, Drug Therapy, Combination, Europe, Humans, Janus Kinase Inhibitors/therapeutic use, Societies, Medical, Synthetic Drugs/economics, Systematic Reviews as Topic, Tumor Necrosis Factor-alpha/antagonists & inhibitors",

author = "Smolen, {Josef S} and Landew{\'e}, {Robert B M} and Bijlsma, {Johannes W J} and Burmester, {Gerd R} and Maxime Dougados and Andreas Kerschbaumer and McInnes, {Iain B} and Alexandre Sepriano and {van Vollenhoven}, {Ronald F} and {de Wit}, Maarten and Daniel Aletaha and Martin Aringer and John Askling and Alejandro Balsa and Maarten Boers and {den Broeder}, {Alfons A} and Buch, {Maya H} and Frank Buttgereit and Roberto Caporali and Cardiel, {Mario Humberto} and {De Cock}, Diederik and Catalin Codreanu and Maurizio Cutolo and Edwards, {Christopher John} and {van Eijk-Hustings}, Yvonne and Paul Emery and Axel Finckh and Laure Gossec and Jacques-Eric Gottenberg and Hetland, {Merete Lund} and Huizinga, {Tom W J} and Marios Koloumas and Zhanguo Li and Xavier Mariette and Ulf M{\"u}ller-Ladner and Mysler, {Eduardo F} and {da Silva}, {Jose A P} and Gyula Po{\'o}r and Pope, {Janet E} and Andrea Rubbert-Roth and Adeline Ruyssen-Witrand and Saag, {Kenneth G} and Anja Strangfeld and Tsutomu Takeuchi and Marieke Voshaar and Ren{\'e} Westhovens and {van der Heijde}, D{\'e}sir{\'e}e",

note = "COPECARE",

year = "2020",

month = jun,

doi = "10.1136/annrheumdis-2019-216655",

language = "English",

volume = "79",

pages = "685--699",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "B M J Group",

number = "6",

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TY - JOUR

T1 - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

T2 - 2019 update

AU - Smolen, Josef S

AU - Landewé, Robert B M

AU - Bijlsma, Johannes W J

AU - Burmester, Gerd R

AU - Dougados, Maxime

AU - Kerschbaumer, Andreas

AU - McInnes, Iain B

AU - Sepriano, Alexandre

AU - van Vollenhoven, Ronald F

AU - de Wit, Maarten

AU - Aletaha, Daniel

AU - Aringer, Martin

AU - Askling, John

AU - Balsa, Alejandro

AU - Boers, Maarten

AU - den Broeder, Alfons A

AU - Buch, Maya H

AU - Buttgereit, Frank

AU - Caporali, Roberto

AU - Cardiel, Mario Humberto

AU - De Cock, Diederik

AU - Codreanu, Catalin

AU - Cutolo, Maurizio

AU - Edwards, Christopher John

AU - van Eijk-Hustings, Yvonne

AU - Emery, Paul

AU - Finckh, Axel

AU - Gossec, Laure

AU - Gottenberg, Jacques-Eric

AU - Hetland, Merete Lund

AU - Huizinga, Tom W J

AU - Koloumas, Marios

AU - Li, Zhanguo

AU - Mariette, Xavier

AU - Müller-Ladner, Ulf

AU - Mysler, Eduardo F

AU - da Silva, Jose A P

AU - Poór, Gyula

AU - Pope, Janet E

AU - Rubbert-Roth, Andrea

AU - Ruyssen-Witrand, Adeline

AU - Saag, Kenneth G

AU - Strangfeld, Anja

AU - Takeuchi, Tsutomu

AU - Voshaar, Marieke

AU - Westhovens, René

AU - van der Heijde, Désirée

N1 - COPECARE

PY - 2020/6

Y1 - 2020/6

N2 - 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.

AB - 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.

KW - Antirheumatic Agents/economics

KW - Arthritis, Rheumatoid/drug therapy

KW - Biological Products/economics

KW - Consensus

KW - Drug Therapy, Combination

KW - Europe

KW - Humans

KW - Janus Kinase Inhibitors/therapeutic use

KW - Societies, Medical

KW - Synthetic Drugs/economics

KW - Systematic Reviews as Topic

KW - Tumor Necrosis Factor-alpha/antagonists & inhibitors

U2 - 10.1136/annrheumdis-2019-216655

DO - 10.1136/annrheumdis-2019-216655

M3 - Journal article

C2 - 31969328

SN - 0003-4967

VL - 79

SP - 685

EP - 699

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 6

ER -

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

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Keywords

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