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

Josef S Smolen, Robert Landewé, Ferdinand C Breedveld, Maxime Dougados, Paul Emery, Cecile Gaujoux-Viala, Simone Gorter, Rachel Knevel, Jackie Nam, Monika Schoels, Daniel Aletaha, Maya Buch, Laure Gossec, Tom Huizinga, Johannes W J W Bijlsma, Gerd Burmester, Bernard Combe, Maurizio Cutolo, Cem Gabay, Juan Gomez-Reino, Marios Kouloumas, Tore K Kvien, Emilio Martin-Mola, Iain McInnes, Karel Pavelka, Piet van Riel, Marieke Scholte, David L Scott, Tuulikki Sokka, Guido Valesini, Ronald van Vollenhoven, Kevin L Winthrop, John Wong, Angela Zink, Désirée van der Heijde, Josef S Smolen, Robert Landewé, Ferdinand C Breedveld, Maxime Dougados, Paul Emery, Cecile Gaujoux-Viala, Simone Gorter, Rachel Knevel, Jackie Nam, Monika Schoels, Daniel Aletaha, Maya Buch, Laure Gossec, Tom Huizinga, Johannes W J W Bijlsma, Gerd Burmester, Bernard Combe, Maurizio Cutolo, Cem Gabay, Juan Gomez-Reino, Marios Kouloumas, Tore K Kvien, Emilio Martin-Mola, Iain McInnes, Karel Pavelka, Piet van Riel, Marieke Scholte, David L Scott, Tuulikki Sokka, Guido Valesini, Ronald van Vollenhoven, Kevin L Winthrop, John Wong, Angela Zink, Désirée van der Heijde

Abstract

Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.

Conflict of interest statement

Competing interests: The following authors declare that they have no potential conflict of interest: CG-V, SG, RK, MK, JN, MS, JW. The following authors declare a potential conflict of interest having received grant support and/or honoraria for consultations and/or for presentations as indicated; JSS: Abbott, Amgen, BMS, Centocor, Pfizer, Roche, Schering-Plough,UCB, Sanofi-Aventis, Wyeth; RL: Abbott, Amgen, BMS, Centocor, Merck, Pfizer, Schering-Plough, UCB, Wyeth; FCB: Abbott, Schering-Plough, Wyeth; MD: Pfizer, Wyeth, Abbott, Roche, Novartis, Nordic Pharma, BMS, UCB; PE: Abbot, BMS, Centocor, Pfizer, Roche, Schering-Plough,UCB, Sanofi-Aventis, Wyeth; MS: Abbott; DA: Abbott, Roche, Schering-Plough, BMS, UCB, Sanofi-Aventis; MB: Roche, Abbott, BMS, Wyeth; LG: Abbott, Schering-Plough, Roche, UCB, BMS, Wyeth; TH: Schering Plough, BMS, Biotest, Wyeth, Novartis, Roche, Sanofi-Aventis, Abbott, Axis-Shield; JWJWB: Abbott, Roche, Wyeth, Schering Plough, Merck, Pfizer, UCB, BMS; GB: Abbott, Wyeth, Schering-Plough, Roche and UCB; BC: Abbott,BMS, Roche, Schering, UCB,Wyeth; MC: Sanofi-Aventis, BMS, Pfizer, Abbott; CG: Roche, BMS, Abbott, Essex, Wyeth, UCB; JG-R: Abbott, BMS, Pfizer, Roche, Schering-Plough,Wyeth and UCB; TKK: Abbott, BMS, Roche, Schering-Plough,Wyeth, Pfizer, MSD and UCB; EMM: Wyeth/Pfizer, Roche, Abbott Schering Plough/MSD; IM: Schering Plough, Pfizer, Roche and BMS; KP: Roche, Abbott, BMS, Pfizer, MSD; PvR: Abbott, BMS, Roche, Sanofi-Aventis, Schering-Plough, UCB, Wyeth; DLS: MSD, Pfizer, Novartis, Roche, Wyeth, Novartis, Schering Plough; TS: Abbott, Pfizer, Sanofi-Aventis, Roche, UCB; GV: Abbott, BMS, Roche, Sanofi-Aventis, Schering-Plugh, UCB, Wyeth; RvV: Abbott, Pfizer/Wyeth, Roche, Schering-Plough, BMS, UCB; KLW: Amgen, Wyeth, UCB, Genentech; AZ: Abbott, Amgen, BMS, Essex/Schering-Plough, Merck, Pfizer, Roche, Sanofi, UCB, Wyeth; DvdH: Abbott, Amgen, BMS, Centocor, Chugai, Merck, Pfizer, Roche, Schering-Plough,UCB, Wyeth. Francis Berenbaum was the Handling Editor.

Figures

Figure 1
Figure 1
Algorithm based on the European League Against Rheumatism recommendations on rheumatoid arthritis management. DMARD, disease-modifying antirheumatic drug; MTX, methotrexate; RF/ACPA, rheumatoid factor/anti-citrullinated peptide antibodies; TNF, tumour necrosis factor. *The treatment target is clinical remission or, if remission is unlikely to be achievable, at least low disease activity.

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Source: PubMed

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