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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; Burmester, Gerd R; Dougados, Maxime; Kerschbaumer, Andreas; McInnes, Iain B; Sepriano, Alexandre; van Vollenhoven, Ronald F; de Wit, Maarten; Aletaha, Daniel; Aringer, Martin; Askling, John; Balsa, Alejandro; Boers, Maarten; den Broeder, Alfons A; Buch, Maya H; Buttgereit, Frank; Caporali, Roberto; Cardiel, Mario Humberto; De Cock, Diederik; Codreanu, Catalin; Cutolo, Maurizio; Edwards, Christopher John; van Eijk-Hustings, Yvonne; Emery, Paul; Finckh, Axel; Gossec, Laure; Gottenberg, Jacques-Eric; Hetland, Merete Lund; Huizinga, Tom W J; Koloumas, Marios; Li, Zhanguo; Mariette, Xavier; Müller-Ladner, Ulf; Mysler, Eduardo F; da Silva, Jose A P; Poór, Gyula; Pope, Janet E; Rubbert-Roth, Andrea; Ruyssen-Witrand, Adeline; Saag, Kenneth G; Strangfeld, Anja; Takeuchi, Tsutomu; Voshaar, Marieke; Westhovens, René; van der Heijde, Désirée.
Afiliação
  • Smolen JS; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria josef.smolen@meduniwien.ac.at.
  • Landewé RBM; Amsterdam University Medical Center, Amsterdam, The Netherlands.
  • Bijlsma JWJ; Zuyderland Medical Center, Heerlen, The Netherlands.
  • Burmester GR; Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Dougados M; Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany.
  • Kerschbaumer A; Rhumatologie B, Hopital Cochin, 27 rue du Fbg Saint-Jacques, Paris, France.
  • McInnes IB; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
  • Sepriano A; Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
  • van Vollenhoven RF; NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
  • de Wit M; Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
  • Aletaha D; EULAR Patient Research Partner; Department Medical Humanities, Amsterdam University Medical Center, Amsterdam, The Netherlands.
  • Aringer M; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
  • Askling J; Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany.
  • Balsa A; Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
  • Boers M; Servicio de Reumatologia Hospital Universitario La Paz, Instituto de Investigacion IdiPAZ, Madrid, Spain.
  • den Broeder AA; Department of Epidemiology and Biostatistics and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
  • Buch MH; Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
  • Buttgereit F; Division of Musculoskeletal and Dermatological Sciences, University of Manchester; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
  • Caporali R; Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany.
  • Cardiel MH; Department of Clinical Sciences and Community Health, University of Milan, and IRCCS S Matteo Foundation, Pavia, Italy.
  • De Cock D; Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán, Mexico.
  • Codreanu C; Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
  • Cutolo M; Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania.
  • Edwards CJ; Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine - University of Genoa, Genoa, Italy.
  • van Eijk-Hustings Y; Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton, Southampton, UK.
  • Emery P; Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands.
  • Finckh A; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
  • Gossec L; Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.
  • Gottenberg JE; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris and Pitié Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France.
  • Hetland ML; Strasbourg University Hospital and University of Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg, France.
  • Huizinga TWJ; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  • Koloumas M; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
  • Li Z; European League Against Rheumatism, Zurich, Switzerland.
  • Mariette X; Cyprus League against Rheumatism, Nikosia, Cyprus.
  • Müller-Ladner U; Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China.
  • Mysler EF; Université Paris-Sud, AP-HP, Université Paris-Saclay, Le Kremlin Bicêtre, France.
  • da Silva JAP; Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig University Giessen, Bad Nauheim, Germany.
  • Poór G; Organización Médica de Investigación, Buenos Aires, Argentina.
  • Pope JE; Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, and Coimbra Institute for Clinical and Biomedical Research (i-CRB), Faculty of Medicine of Coimbra, Coimbra, Portugal.
  • Rubbert-Roth A; National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary.
  • Ruyssen-Witrand A; University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine, London, Ontario, Canada.
  • Saag KG; Klinik für Rheumatologie, Kantonsspital St Gallen, St Gallen, Switzerland.
  • Strangfeld A; UMR 1027, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France.
  • Takeuchi T; Department of Medicine, Division of Rheumatology, University of Alabama at Birmingham, Brmingham, Alabama, USA.
  • Voshaar M; Programme Area Epidemiology, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany.
  • Westhovens R; Keio University School of Medicine, Keio University Hospital, Tokyo, Japan.
  • van der Heijde D; Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
Ann Rheum Dis ; 79(6): 685-699, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31969328
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.
Assuntos
Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Artrite Reumatoide / Sociedades Médicas / Produtos Biológicos / Antirreumáticos / Medicamentos Sintéticos Tipo de estudo: Guia de prática clínica / Estudo prognóstico / Fatores de risco Limite: Humanos País/Região como assunto: Europa Idioma: Inglês Revista: Ann Rheum Dis Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Áustria

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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Artrite Reumatoide / Sociedades Médicas / Produtos Biológicos / Antirreumáticos / Medicamentos Sintéticos Tipo de estudo: Guia de prática clínica / Estudo prognóstico / Fatores de risco Limite: Humanos País/Região como assunto: Europa Idioma: Inglês Revista: Ann Rheum Dis Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Áustria