EULAR recommendations for the management of rheumatoid arthritis – differences between versions from 2013 and 2010
Authors:
K. Pavelka
Authors‘ workplace:
Revmatologický ústav, Praha
Published in:
Čes. Revmatol., 22, 2014, No. 2, p. 70-80.
Category:
Recommendation
Overview
European League against Rheumatism (EULAR) has appointed a committee of experts (the so called Task Force), which published a new version of the EULAR recommendations for the treatment of rheumatoid arthritis (RA).
Methodology:
The recommended methodology for the creation of all official EULAR recommendations was applied. After the appointment of the committee a EULAR general methodology, used in production of official EULAR recommendations, was applied. A literature review of all English-language publications from the years 2009–2012 was performed, which supplemented the original evidence from 2010. Every quality randomized, controlled clinical trial published as a full-text article or an abstract from EULAR congresses 2012–2013 was included. Based on evidence, the individual recommendations were proposed and subsequently underwent a total of 5 rounds of the so-called Delphi method. Finally, three overarching principles and a total of 14 recommendations were defined.
Results:
The major differences between the new and the old recommendations include: achieving a low activity or remission at 6 months, however, achieving at least response to treatment with csDMARDs after 3 months; initiation of MTX therapy either as a monotherapy or in combination with more csDMARDs (MTX + SAS + HCQ); more emphasis on the application of glucocorticoids in early RA in combination with MTX (csDMARDs), however, limited to six months of application; anti-TNF inhibitors, abatacept, tocilizumab, and rituximab in certain circumstances are recommended after failure of MTX as the first biological drug; biosimilars are listed as an alternative – to date, biosimilar infliximab has already been approved; tofacitinib is mentioned, which may be applied only after failure of at least one anti-TNF drug. Recently, EMA has refused its registration.
Key words:
Rheumatoid arthritis, EULAR recommendations, therapy
Sources
1. Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2013; doi:10.1136/annrheumdis-2013-204573.
2. Smolen JS, Landewe R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010; 69(6): 964–975.
3. Yoo DH, Hrycaj P, Miranda P, Ramiterre E, Piotrowski M, Shevchuk S et al. A randomised, double-blind, parallel-group study to demonstrate equivalence in efficacy and safety of CT-P13 compared with innovator infliximab when coadministered with methotrexate in patients with active rheumatoid arthritis: the PLANETRA study. Ann Rheum Dis 2013;72(10): 1613–20.
4. Radner H, Neogi T, Smolen JS, Aletaha D. Performance of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: a systematic literature review. Ann Rheum Dis 2013, v tisku.
5. Klarenbeek NB, Koevoets R, Van der Heijde DM, Gerards AH, Ten WS, Kerstens PJ et al. Association with joint damage and physical functioning of nine composite indices and the 2011 ACR/EULAR remission criteria in rheumatoid arthritis. Ann Rheum Dis 2011; 70(10): 1815–1821.
6. Gaujoux-Viala C, Gossec L, et al. Efficacy of conventional synthetic DMARDs, glucocorticoids and tofacitinib - a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis 2013; submitted.
7. Sharp JT, Strand V, Leung H, Hurley F, Loew-Friedrich I. Treatment with leflunomide slows radiographic progression of rheumatoid arthritis. Results from three randomized controlled trials of leflunomide in patients with active rheumatoid arthritis. Arthritis Rheum 2000; 43: 495–505.
8. Katchamart W, Trudeau J, Phumethum V, Bombardier C. Efficacy and toxicity of methotrexate (MTX) monotherapy versus MTX combination therapy with non-biological disease-modifying antirheumatic drugs in rheumatoid arthritis: a systematic review and meta-analysis. Ann Rheum Dis 2009; 68(7): 1105–1112.
9. de Jong PH, Hazes JM, Barendregt PJ, Huisman M, van ZD, van der Lubbe PA et al. Induction therapy with a combination of DMARDs is better than methotrexate monotherapy: first results of the tREACH trial. Ann Rheum Dis 2013; 72(1): 72–78.
10. Moreland LW, O'Dell JR, Paulus HE, Curtis JR, Bathon JM, St Clair EW et al. A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: the treatment of Early Aggressive Rheumatoid Arthritis Trial. Arthritis Rheum 2012; 64(9): 2824–2835.
11. Bakker MF, Jacobs JW, Welsing PM, Verstappen SM, Tekstra J, Ton E et al. Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis: A Randomized Trial. Ann Intern Med 2012; 156(5): 329–339.
12. Canalis E, Mazziotti G, Giustina A, Bilezikian JP: (2007) Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 18: 1319–1328.
13. van Vollenhoven RF, Geborek P, Forslind K, Albertsson K, Ernestam S, Petersson IF et al. Conventional combination treatment versus biological treatment in methotrexate-refractory early rheumatoid arthritis: 2 year follow-up of the randomised, non-blinded, parallel-group Swefot trial. Lancet 2012; 379(9827): 1712–20.
14. Genovese MC, McKay JD, Nasonov EL et al. Interleukin-6 receptor inhibition with tocilizumab reduces disease activity in rheumatoid arthritis with inadequate response to disease-modifying antirheumatic drugs: the tocilizumab in combination with traditional disease-modifying antirheumatic drug therapy study. Arthritis Rheum. 2008; 58: 2968–80.
15. Schiff M, Keiserman M, Codding C et al. Efficacy and safety of abatacept or infliximab vs placebo in ATTEST: a phase III, multi-centre, randomised, double-blind, placebo-controlled study in patients with rheumatoid arthritis and an inadequate response to methotrexate. Ann Rheum Dis 2008; 67: 1096–103.
16. Gabay C, Emery P, van VR, Dikranian A, Alten R, Pavelka K et al. Tocilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA): a randomised, double-blind, controlled phase 4 trial. Lancet 2013; 381(9877): 1541–1550.
17. van Vollenhoven RF, Fleischmann R, Cohen S, Lee EB, Garcia Meijide JA, Wagner S et al. Tofacitinib or adalimumab versus placebo in rheumatoid arthritis. N Engl J Med 2012; 367(6): 508–519.
18. Kavanaugh A, Emery P, Felischmann RM, et al.: Withrawal of adalimumab in early rheumatoid arthritis patients who attained stable low disease activity with adalimumab plus methotrexate: esults of a phase 4, double-blind, placebo-controlled trial. Rheumatology (Oxford) 2012; 51 (Suppl 3): iii27.
19. Smolen JS, Nash P, Durez P, Hall S, Ilivanova E, Irazoque-Palazuelos F et al. Maintenance, reduction, or withdrawal of etanercept after treatment with etanercept and methotrexate in patients with moderate rheumatoid arthritis (PRESERVE): a randomised controlled trial. Lancet 2013; 381(9870): 918–929.
20. Felson DT, Smolen JS, Wells G et al. American College of Rheumatology/European League Against Rheumatism Provisional Definition of Remission in Rheumatoid Arthritis for Clinical Trials. Ann Rheum Dis 2011; 70: 404–413.
Labels
Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2014 Issue 2
Most read in this issue
- Metatarsalgia in patients with rheumatoid arthritis
- Peripheral ulcerative keratitis – a severe complication of rheumatoid arthritis
- Recommendations of the Czech Society for Rheumatology for the diagnosis of systemic sclerosis
- 18F-FDG PET and PET/CT examination in patients with giant cell arteritis – a practical view from a PET center