The European League Against Rheumatism (EULAR) has released updated recommendations for the management of RA. According to this latest guidance, treatment with disease-modifying anti-rheumatic drugs (DMARDs) should be initiated as soon as a diagnosis of RA is made, with the aim of reaching a target of remission or low disease activity in every patient.
As first-line treatment, EULAR recommends rheumatologists administer methotrexate (MTX) or combination therapy of MTX with other conventional synthetic DMARDs. Low-dose glucocorticoids should also be considered in combination with DMARDs for up to six months, but should be tapered as soon as clinically feasible.
"These recommendations were based on three extensive literature reviews of the efficacy and safety of biological and conventional DMARDs, and address a number of common misinterpretations of the 2010 guidelines," according to Professor Josef Smolen, Medical University of Vienna and Hietzing Hospital, Vienna. "As already stated in 2010, by advocating the use of synthetic DMARDs, rather than biologics, as the first-line treatment this approach avoids the over-treatment of 20-50% of patients with early RA, who will achieve the treatment target with such initial therapy" he concluded for the Task Force.
However, in patients failing to respond to this treatment within 6 months and when poor prognostic factors are present, biological DMARDs (TNF-inhibitors, abatacept or tocilizumab or under certain circumstances rituximab) should be administered in combination with MTX.
The document further recommends that patients who have failed to respond to an initial biologic DMARD should receive another biologic DMARD. Patients who have failed to respond to an initial TNF-inhibitor may receive another TNF-inhibitor, or a biologic with an alternative mode of action. If biologic treatment has failed, tofacitinib may be considered where approved.
"Although the European Medicin
|Contact: EULAR Press Office|
European League Against Rheumatism