Open Access

Annals of the Rheumatic Diseases

, том 82 , издание 1 , страницы ard-2022-223356

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

Тип публикации: Journal Article

Дата публикации: 2022-11-10

Elsevier

Annals of the Rheumatic Diseases

SCImago Q1

Tоп 10% SCImago

WOS Q1

БС1

SJR: 7.286

CiteScore: 33.2

Impact factor: 20.6

ISSN: 00034967, 14682060

DOI: 10.1136/ard-2022-223356

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PubMed ID: 36357155

General Biochemistry, Genetics and Molecular Biology

Immunology

Immunology and Allergy

Rheumatology

Краткое описание

Objectives

To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field.

Methods

An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item.

Results

The task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3–6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations.

Conclusions

These updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.

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Smolen J. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update // Annals of the Rheumatic Diseases. 2022. Vol. 82. No. 1. p. ard-2022-223356.

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TY - JOUR

DO - 10.1136/ard-2022-223356

UR - https://doi.org/10.1136/ard-2022-223356

TI - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

T2 - Annals of the Rheumatic Diseases

AU - Smolen, J.

AU - Landew??, Robert

AU - Bergstra, Sytske Anne

AU - Kerschbaumer, Andreas

AU - Sepriano, Alexandre Rocha

AU - Aletaha, Daniel

AU - Caporali, Roberto

AU - Edwards, Christopher John

AU - Hyrich, Kimme

AU - Pope, Janet E.

AU - De Souza, Savia

AU - Stamm, Tanja A

AU - Takeuchi, Tsutomu

AU - Verschueren, Patrick

AU - Winthrop, Kevin

AU - Balsa, Alejandro C.

AU - Bathon, Joan M.

AU - Buch, Maya H

AU - Burmester, Gerd-Rüdiger

AU - Buttgereit, Frank

AU - Cardiel, Mario Humberto

AU - Chatzidionysiou, K

AU - Codreanu, Catalin

AU - Cutolo, Maurizio

AU - den Broeder, Alfons A

AU - El Aoufy, Khadija

AU - Finckh, A

AU - Fonseca, João Eurico

AU - Gottenberg, Jacques-Eric

AU - Haavardsholm, Espen A

AU - Iagnocco, Annamaria

AU - Lauper, Kim

AU - Li, Zhanguo

AU - McInnes, Iain B.

AU - Mysler, Eduardo F

AU - Nash, P.

AU - Poor, Gyula

AU - Ristic, Gorica G

AU - Rivellese, Felice

AU - Rubbert-Roth, Andrea

AU - Schulze-Koops, Hendrik

AU - Stoilov, Nikolay

AU - Strangfeld, Anja

AU - Van Der Helm Van Mil, Annette

AU - Van Duuren, Elsa

AU - Vliet Vlieland, Theodora PM

AU - Westhovens, R

AU - Heijde, Désirée van der

PY - 2022

DA - 2022/11/10

PB - Elsevier

SP - ard-2022-223356

IS - 1

VL - 82

PMID - 36357155

SN - 0003-4967

SN - 1468-2060

ER -

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@article{2022_Smolen,

author = {J. Smolen and Robert Landew?? and Sytske Anne Bergstra and Andreas Kerschbaumer and Alexandre Rocha Sepriano and Daniel Aletaha and Roberto Caporali and Christopher John Edwards and Kimme Hyrich and Janet E. Pope and Savia De Souza and Tanja A Stamm and Tsutomu Takeuchi and Patrick Verschueren and Kevin Winthrop and Alejandro C. Balsa and Joan M. Bathon and Maya H Buch and Gerd-Rüdiger Burmester and Frank Buttgereit and Mario Humberto Cardiel and K Chatzidionysiou and Catalin Codreanu and Maurizio Cutolo and Alfons A den Broeder and Khadija El Aoufy and A Finckh and João Eurico Fonseca and Jacques-Eric Gottenberg and Espen A Haavardsholm and Annamaria Iagnocco and Kim Lauper and Zhanguo Li and Iain B. McInnes and Eduardo F Mysler and P. Nash and Gyula Poor and Gorica G Ristic and Felice Rivellese and Andrea Rubbert-Roth and Hendrik Schulze-Koops and Nikolay Stoilov and Anja Strangfeld and Annette Van Der Helm Van Mil and Elsa Van Duuren and Theodora PM Vliet Vlieland and R Westhovens and Désirée van der Heijde and others},

title = {EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update},

journal = {Annals of the Rheumatic Diseases},

year = {2022},

volume = {82},

publisher = {Elsevier},

month = {nov},

url = {https://doi.org/10.1136/ard-2022-223356},

number = {1},

pages = {ard--2022--223356},

doi = {10.1136/ard-2022-223356}

}

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Smolen, J., et al. “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update.” Annals of the Rheumatic Diseases, vol. 82, no. 1, Nov. 2022, pp. ard-2022-223356. https://doi.org/10.1136/ard-2022-223356.

Издатель

Elsevier

Журнал

Annals of the Rheumatic Diseases

SCImago Q1

Tоп 10% SCImago

WOS Q1

БС1