EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

Josef S. Smolen, Robert Landewé, Ferdinand C. Breedveld, Maya Buch, Gerd Burmester, Maxime Dougados, Paul Emery, Cécile Gaujoux-Viala, Laure Gossec, Jackie Nam, Sofia Ramiro, Kevin Winthrop, Maarten De Wit, Daniel Aletaha, Neil Betteridge, Johannes W J Bijlsma, Maarten Boers, Frank Buttgereit, Bernard Combe, Maurizio CutoloNemanja Damjanov, Johanna M W Hazes, Marios Kouloumas, Tore K. Kvien, Xavier Mariette, Karel Pavelka, Piet L C M Van Riel, Andrea Rubbert-Roth, Marieke Scholte-Voshaar, David L. Scott, Tuulikki Sokka-Isler, John B. Wong, Désirée Van Der Heijde

Research output: Contribution to journalArticle

1364 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)492-509
Number of pages18
JournalAnnals of the Rheumatic Diseases
Volume73
Issue number3
DOIs
StatePublished - Mar 1 2014

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Biosimilar Pharmaceuticals
Antirheumatic Agents
Rheumatic Diseases
Glucocorticoids
Rheumatoid Arthritis
Consensus
Safety
Expert Testimony
Rheumatology
Advisory Committees
Politics
Therapeutics
Tumor Necrosis Factor-alpha
Decision making
Decision Making
Rheumatologists

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs : 2013 update. / Smolen, Josef S.; Landewé, Robert; Breedveld, Ferdinand C.; Buch, Maya; Burmester, Gerd; Dougados, Maxime; Emery, Paul; Gaujoux-Viala, Cécile; Gossec, Laure; Nam, Jackie; Ramiro, Sofia; Winthrop, Kevin; De Wit, Maarten; Aletaha, Daniel; Betteridge, Neil; Bijlsma, Johannes W J; Boers, Maarten; Buttgereit, Frank; Combe, Bernard; Cutolo, Maurizio; Damjanov, Nemanja; Hazes, Johanna M W; Kouloumas, Marios; Kvien, Tore K.; Mariette, Xavier; Pavelka, Karel; Van Riel, Piet L C M; Rubbert-Roth, Andrea; Scholte-Voshaar, Marieke; Scott, David L.; Sokka-Isler, Tuulikki; Wong, John B.; Van Der Heijde, Désirée.

In: Annals of the Rheumatic Diseases, Vol. 73, No. 3, 01.03.2014, p. 492-509.

Research output: Contribution to journalArticle

Smolen, JS, Landewé, R, Breedveld, FC, Buch, M, Burmester, G, Dougados, M, Emery, P, Gaujoux-Viala, C, Gossec, L, Nam, J, Ramiro, S, Winthrop, K, De Wit, M, Aletaha, D, Betteridge, N, Bijlsma, JWJ, Boers, M, Buttgereit, F, Combe, B, Cutolo, M, Damjanov, N, Hazes, JMW, Kouloumas, M, Kvien, TK, Mariette, X, Pavelka, K, Van Riel, PLCM, Rubbert-Roth, A, Scholte-Voshaar, M, Scott, DL, Sokka-Isler, T, Wong, JB & Van Der Heijde, D 2014, 'EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update', Annals of the Rheumatic Diseases, vol. 73, no. 3, pp. 492-509. https://doi.org/10.1136/annrheumdis-2013-204573
Smolen, Josef S. ; Landewé, Robert ; Breedveld, Ferdinand C. ; Buch, Maya ; Burmester, Gerd ; Dougados, Maxime ; Emery, Paul ; Gaujoux-Viala, Cécile ; Gossec, Laure ; Nam, Jackie ; Ramiro, Sofia ; Winthrop, Kevin ; De Wit, Maarten ; Aletaha, Daniel ; Betteridge, Neil ; Bijlsma, Johannes W J ; Boers, Maarten ; Buttgereit, Frank ; Combe, Bernard ; Cutolo, Maurizio ; Damjanov, Nemanja ; Hazes, Johanna M W ; Kouloumas, Marios ; Kvien, Tore K. ; Mariette, Xavier ; Pavelka, Karel ; Van Riel, Piet L C M ; Rubbert-Roth, Andrea ; Scholte-Voshaar, Marieke ; Scott, David L. ; Sokka-Isler, Tuulikki ; Wong, John B. ; Van Der Heijde, Désirée. / EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs : 2013 update. In: Annals of the Rheumatic Diseases. 2014 ; Vol. 73, No. 3. pp. 492-509.
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AU - Smolen, Josef S.

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AU - Breedveld, Ferdinand C.

AU - Buch, Maya

AU - Burmester, Gerd

AU - Dougados, Maxime

AU - Emery, Paul

AU - Gaujoux-Viala, Cécile

AU - Gossec, Laure

AU - Nam, Jackie

AU - Ramiro, Sofia

AU - Winthrop, Kevin

AU - De Wit, Maarten

AU - Aletaha, Daniel

AU - Betteridge, Neil

AU - Bijlsma, Johannes W J

AU - Boers, Maarten

AU - Buttgereit, Frank

AU - Combe, Bernard

AU - Cutolo, Maurizio

AU - Damjanov, Nemanja

AU - Hazes, Johanna M W

AU - Kouloumas, Marios

AU - Kvien, Tore K.

AU - Mariette, Xavier

AU - Pavelka, Karel

AU - Van Riel, Piet L C M

AU - Rubbert-Roth, Andrea

AU - Scholte-Voshaar, Marieke

AU - Scott, David L.

AU - Sokka-Isler, Tuulikki

AU - Wong, John B.

AU - Van Der Heijde, Désirée

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N2 - 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.

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