EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

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, 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, Karateev, Dmitry, Kouloumas, Marios, Kvien, Tore, Li, Zhanguo, Mariette, Xavier, McInnes, Iain, Mysler, Eduardo, Nash, Peter, Pavelka, Karel, Poor, Gyula, Richez, Christophe, van Riel, Piet, Rubbert-Roth, Andrea, Saag, Kenneth, da Silva, Jose, Stamm, Tanja, Takeuchi, Tsutomu, Westhovens, Rene, de Wit, Maarten and van der Heijde, Desiree (2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Annals of the Rheumatic Diseases, 76 6: 960-977. doi:10.1136/annrheumdis-2016-210715

Author 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
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
Karateev, Dmitry
Kouloumas, Marios
Kvien, Tore
Li, Zhanguo
Mariette, Xavier
McInnes, Iain
Mysler, Eduardo
Nash, Peter
Pavelka, Karel
Poor, Gyula
Richez, Christophe
van Riel, Piet
Rubbert-Roth, Andrea
Saag, Kenneth
da Silva, Jose
Stamm, Tanja
Takeuchi, Tsutomu
Westhovens, Rene
de Wit, Maarten
van der Heijde, Desiree
Title EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update
Journal name Annals of the Rheumatic Diseases   Check publisher's open access policy
ISSN 0003-4967
Publication date 2017-06-01
Year available 2017
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1136/annrheumdis-2016-210715
Open Access Status Not yet assessed
Volume 76
Issue 6
Start page 960
End page 977
Total pages 18
Place of publication London, United Kingdom
Publisher B M J Group
Language eng
Subject 2745 Rheumatology
2723 Immunology and Allergy
2403 Immunology
1300 Biochemistry, Genetics and Molecular Biology
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.
Keyword Disease Activity
DMARDs (biologic)
DMARDs (synthetic)
Rheumatoid Arthritis
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID G1000417
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: HERDC Pre-Audit
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