EULAR Recommendations for the Management of Rheumatoid Arthritis – 2019 Update and Consensus Statement on JAKinibs

Ann Rheum Dis. 2020 Jan 22. pii: annrheumdis-2019-216655.

The EULAR recommendations for the management of RA have become increasingly useful in providing rheumatologists, patients, payers and other stakeholders with the evidence-based guidance and views of experts on the optimal use and sequence of pharmaceutical therapies in patients with RA. Over the course of the last decade, the evolution of the treatment landscape has already required two updates. The release of the new addition updates the 2016 recommendations.An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned, with participants voting independently on their level of agreement with each of the items. The task force agreed on 5 overarching principles and 12 recommendations concerning the use of DMARDs. Adhering to these recommendations, based on systematic literature reviews and opinions of experts from around the world, will allow optimal treatment of patients with RA.From the new update, overarching principle D was added, and the following recommendations were revised.Overarching Principle D - Patients require access to multiple drugs with different modes of action to address the heterogeneity of RA; they may require multiple successive therapies throughout life.Recommendation 8 - If the treatment target is not achieved with the first csDMARD strategy, when and poor prognostic factors are present, a bDMARD or a tsDMARD should be added.Recommendation 10 - If a bDMARD or tsDMARD has failed, treatment with another bDMARD or a tsDMARD should be considered; if one TNF inhibitor therapy has failed, patients may receive an agent with another mode of action or a second TNF inhibitor.Recommendation 11 - If a patient is in persistent remission after having tapered glucocorticoids, one can consider tapering bDMARDs or tsDMARDs, especially if this treatment is combined with a csDMARD.All other overarching principles and recommendations remained unchanged.