2. Academic Validation
  3. Efficacy of pharmacological treatment in rheumatoid arthritis: a systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis

Efficacy of pharmacological treatment in rheumatoid arthritis: a systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis

  • Ann Rheum Dis. 2020 Jun;79(6):744-759. doi: 10.1136/annrheumdis-2019-216656.
Andreas Kerschbaumer 1,  Alexandre Sepriano 2 3,  Josef S Smolen 4,  Désirée van der Heijde 2,  Maxime Dougados 5,  Ronald van Vollenhoven 6,  Iain B McInnes 7,  Johannes W J Bijlsma 8,  Gerd R Burmester 9,  Maarten de Wit 10,  Louise Falzon 11,  Robert Landewé 6
Affiliations

Affiliations

  • 1 Medical University of Vienna, Vienna, Austria [email protected].
  • 2 Leiden University Medical Center, Leiden, The Netherlands.
  • 3 NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
  • 4 Medical University of Vienna, Vienna, Austria.
  • 5 Hospital Cochin, Paris, France.
  • 6 Amsterdam Rheumatology Center, Amsterdam, The Netherlands.
  • 7 University of Glasgow, Glasgow, UK.
  • 8 University Medical Center Utrecht, Utrecht, The Netherlands.
  • 9 Charité - University Medicine Berlin, Berlin, Germany.
  • 10 EULAR Standing Committee, Zurich, Switzerland.
  • 11 Northwell Health, New York, New York, USA.
PMID: 32033937 DOI: 10.1136/annrheumdis-2019-216656
Abstract

Objectives: To inform the 2019 update of the European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA).

Methods: A systematic literature research (SLR) to investigate the efficacy of any disease-modifying antirheumatic drug (DMARD) (conventional synthetic (cs)DMARD, biological (b) and biosimilar DMARD, targeted synthetic (ts)DMARD) or glucocorticoid (GC) therapy in patients with RA was done by searching MEDLINE, Embase and the Cochrane Library for articles published between 2016 and 8 March 2019.

Results: 234 abstracts were selected for detailed assessment, with 136 finally included. They comprised the efficacy of bDMARDs versus placebo or other bDMARDs, efficacy of Janus kinase (JAK) inhibitors (JAKi) across different patient populations and head-to-head of different bDMARDs versus JAKi or other bDMARDs. Switching of bDMARDs to other bDMARDs or tsDMARDs, strategic trials and tapering studies of bDMARDs, csDMARDs and JAKi were assessed. The drugs evaluated included abatacept, adalimumab, ABT-122, baricitinib, certolizumab pegol, SBI-087, CNTO6785, decernotinib, etanercept, filgotinib, golimumab, GCs, GS-9876, guselkumab, hydroxychloroquine, infliximab, leflunomide, mavrilimumab, methotrexate, olokizumab, otilimab, peficitinib, rituximab, sarilumab, salazopyrine, secukinumab, sirukumab, tacrolimus, tocilizumab, tofacitinib, tregalizumab, upadacitinib, ustekinumab and vobarilizumab. The efficacy of many bDMARDs and tsDMARDs was shown. Switching to another tumour necrosis factor inhibitor (TNFi) or non-TNFi bDMARDs after TNFi treatment failure is efficacious. Tapering of DMARDs is possible in patients achieving long-standing stringent clinical remission; in patients with residual disease activity (including patients in LDA) the risk of flares is increased during the tapering. Biosimilars are non-inferior to their reference products.

Conclusion: This SLR informed the task force regarding the evidence base of various therapeutic regimen for the development of the update of EULAR's RA management recommendation.

Keywords

DMARDs (biologic); DMARDs (synthetic); anti-TNF; rheumatoid arthritis.

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