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

Smolen, Josef S.
Landewe, Robert
Breedveld, Ferdinand C.
Dougados, Maxime
Emery, Paul
Gaujoux-Viala, Cecile
Gorter, Simone
Knevel, Rachel
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Published in Annals of the Rheumatic Diseases. 2010, vol. 69, no. 6, p. 964-975
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-a-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.
Keywords AlgorithmsAntirheumatic Agents/economics/*therapeutic useArthritis, Rheumatoid/*drug therapy/economicsCost-Benefit AnalysisEvidence-Based Medicine/methodsGlucocorticoids/economics/*therapeutic useHumansImmunosuppressive Agents/economics/therapeutic useTumor Necrosis Factor-alpha/antagonists & inhibitors
PMID: 20444750
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Research group Mécanisme de l'inflammation articulaire (44)
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SMOLEN, Josef S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. In: Annals of the Rheumatic Diseases, 2010, vol. 69, n° 6, p. 964-975. doi: 10.1136/ard.2009.126532 https://archive-ouverte.unige.ch/unige:21319

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Deposited on : 2012-05-23

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