EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

被引：1923

作者：

Smolen, Josef S. ^{[1
]}

Landewe, Robert B. M. ^{[2
,3
]}

Bijlsma, Johannes W. J. ^{[4
]}

Burmester, Gerd R. ^{[5
,6
]}

Dougados, Maxime ^{[7
]}

Kerschbaumer, Andreas ^{[1
]}

McInnes, Iain B. ^{[8
]}

Sepriano, Alexandre ^{[9
,10
]}

van Vollenhoven, Ronald F. ^{[11
]}

de Wit, Maarten ^{[12
]}

Aletaha, Daniel ^{[1
]}

Aringer, Martin ^{[13
,14
]}

Askling, John ^{[15
]}

Balsa, Alejandro ^{[16
]}

Boers, Maarten ^{[17
,18
]}

den Broeder, Alfons A. ^{[19
]}

Buch, Maya H. ^{[20
,21
]}

Buttgereit, Frank ^{[5
,6
]}

Caporali, Roberto ^{[22
,23
]}

Cardiel, Mario Humberto ^{[24
]}

De Cock, Diederik ^{[25
,26
]}

Codreanu, Catalin ^{[27
]}

Cutolo, Maurizio ^{[28
,29
]}

Edwards, Christopher John ^{[30
]}

van Eijk-Hustings, Yvonne ^{[31
,32
]}

Emery, Paul ^{[33
,34
]}

Finckh, Axel ^{[35
]}

Gossec, Laure ^{[36
,37
]}

Gottenberg, Jacques-Eric ^{[38
,39
]}

Hetland, Merete Lund ^{[40
,41
]}

Huizinga, Tom W. J. ^{[10
]}

Koloumas, Marios ^{[42
,43
]}

Li, Zhanguo ^{[44
]}

Mariette, Xavier ^{[45
]}

Mueller-Ladner, Ulf ^{[46
]}

Mysler, Eduardo F. ^{[47
]}

da Silva, Jose A. P. ^{[48
,49
]}

Poor, Gyula ^{[50
]}

Pope, Janet E. ^{[51
]}

Rubbert-Roth, Andrea ^{[52
]}

Ruyssen-Witrand, Adeline ^{[53
]}

Saag, Kenneth G. ^{[54
]}

Strangfeld, Anja ^{[55
]}

Takeuchi, Tsutomu ^{[56
]}

Voshaar, Marieke ^{[57
]}

Westhovens, Rene ^{[25
,26
]}

van der Heijde, Desiree ^{[10
]}

机构：

[1] Med Univ Vienna, Div Rheumatol, Dept Med 3, A-1090 Vienna, Austria

[2] Univ Amsterdam, Med Ctr, Amsterdam, Netherlands

[3] Zuyderland Med Ctr, Heerlen, Netherlands

[4] Univ Med Ctr Utrecht, Dept Rheumatol & Clin Immunol, Utrecht, Netherlands

[5] Free Univ, Charite Univ Med Berlin, Dept Rheumatol & Clin Immunol, Berlin, Germany

[6] Humboldt Univ, Berlin, Germany

[7] Hop Cochin, Rhumatol B, 27 Rue Fbg St Jacques, Paris, France

[8] Univ Glasgow, Inst Infect Immun & Inflammat, Coll Med Vet & Life Sci, Glasgow, Lanark, Scotland

[9] Univ Nova Lisboa, NOVA Med Sch, Lisbon, Portugal

[10] Leiden Univ, Dept Rheumatol, Med Ctr, Leiden, Netherlands

[11] Vrije Univ Amsterdam, Dept Rheumatol, Med Ctr, Amsterdam, Netherlands

[12] Univ Amsterdam, EULAR Patient Res Partner Dept Med Humanities, Med Ctr, Amsterdam, Netherlands

[13] Univ Med Ctr, Dept Med 3, Div Rheumatol, Dresden, Germany

[14] Fac Med Carl Gustav Carus, Dresden, Germany

[15] Karolinska Univ Hosp, Dept Rheumatol, Stockholm, Sweden

[16] Hosp Univ La Paz, Serv Reumatol, Inst Invest IdiPAZ, Madrid, Spain

[17] Vrije Univ Amsterdam, Dept Epidemiol & Biostat, Amsterdam, Netherlands

[18] Vrije Univ Amsterdam, Amsterdam Rheumatol & Immunol Ctr, Amsterdam, Netherlands

[19] Sint Maartensklin, Dept Rheumatol, Nijmegen, Netherlands

[20] Univ Manchester, Div Musculoskeletal & Dermatol Sci, Manchester, Lancs, England

[21] Manchester Univ NHS Fdn Trust, NIHR Manchester Biomed Res Ctr, Manchester, Lancs, England

[22] Univ Milan, Dept Clin Sci & Community Hlth, Pavia, Italy

[23] IRCCS S Matteo Fdn, Pavia, Italy

[24] Ctr Invest Clin Morelia SC, Morelia, Michoacan, Mexico

[25] Katholieke Univ Leuven, Dept Dev & Regenerat, Skeletal Biol & Engn Res Ctr, Leuven, Belgium

[26] Univ Hosp Leuven, Rheumatol, Leuven, Belgium

[27] Univ Med & Pharm, Ctr Rheumat Dis, Bucharest, Romania

[28] Univ Genoa, Res Lab, Dept Internal Med, Genoa, Italy

[29] Univ Genoa, Div Clin Rheumatol, Dept Internal Med, Genoa, Italy

[30] Univ Hosp Southampton, Musculoskeletal Res Unit, NIHR Clin Res Facil, Southampton, Hants, England

[31] Univ Maastricht, Dept Patient & Care, Maastricht, Netherlands

[32] Univ Maastricht, Dept Rheumatol, Maastricht, Netherlands

[33] Univ Leeds, Leeds Teaching Hosp NHS Trust, NIHR Leeds Musculoskeletal Biomed Res Unit, Leeds, W Yorkshire, England

[34] Univ Leeds, Leeds Inst Rheumat & Musculoskeletal Med, Leeds, W Yorkshire, England

[35] Univ Hosp Geneva, Div Rheumatol, Geneva, Switzerland

[36] Sorbonne Univ, INSERM, Inst Pierre Louis Epidemiol & Sante Publ, Paris, France

[37] Hop La Pitie Salpetriere, AP HP, Rheumatol Dept, Paris, France

[38] Strasbourg Univ Hosp, Strasbourg, France

[39] Univ Strasbourg, CNRS, Inst Biol Mol & Cellulaire, Immunopathol & Chim Therapeut, Strasbourg, France

[40] Rigshospitalet, Copenhagen Ctr Arthrit Res, Ctr Rheumatol & Spine Dis, Copenhagen, Denmark

[41] Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark

[42] European League Rheumatism, Zurich, Switzerland

[43] Cyprus League Rheumatism, Nikosia, Cyprus

[44] Beijing Univ, Dept Rheumatol & Immunol, Peoples Hosp, Beijing, Peoples R China

[45] Univ Paris Saclay, Univ Paris Sud, AP HP, Le Kremlin Bicetre, France

[46] Justus Liebig Univ Giessen, Dept Rheumatol & Clin Immunol, Campus Kerckhoff, Bad Nauheim, Germany

[47] Org Med Invest, Buenos Aires, DF, Argentina

[48] Ctr Hosp & Univ Coimbra Praceta Mota Pinto, Serv Reumatol, Coimbra, Portugal

[49] Coimbra Inst Clin & Biomed Res iCRB, Fac Med Coimbra, Coimbra, Portugal

[50] Semmelweis Univ, Natl Inst Rheumatol & Physiol, Budapest, Hungary

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2020年 / 79卷 / 06期

关键词：

TREAT-TO-TARGET; INTERLEUKIN-6 RECEPTOR INHIBITION; CONSENSUS-BASED RECOMMENDATIONS; RAPID RADIOGRAPHIC PROGRESSION; DOSE GLUCOCORTICOID THERAPY; TREATMENT STRATEGIES; REMISSION INDUCTION; CERTOLIZUMAB PEGOL; RHEUMATOLOGY/EUROPEAN LEAGUE; AMERICAN-COLLEGE;

D O I：

10.1136/annrheumdis-2019-216655

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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.

引用

页码：685 / 699

页数：15

共 127 条

[1]

Survival and effectiveness of leflunomide compared with methotrexate and sulfasalazine in rheumatoid arthritis: a matched observational study [J].