EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs: 2025 update

作者：Josef S Smolen, Christopher J. Edwards, Victoria Konzett, Faidra Laskou, Daniel Aletaha, Roberto Felice Caporali, Thomas Dörner, Kimme Leanne Hyrich, Elsa Frãzao Mateus, Janet E. Pope, Jette Primdahl, Savia de Souza, Tanja A Stamm, Tsutomu Takeuchi, Désirée M F M van der Heijde, Patrick Verschueren, Kevin L. Winthrop, José María Álvaro‐Gracia, Johan Askling, Joan Bathon, Maya H Buch, Gerd Rüdiger Burmester, Cătălin Codreanu, Philip G. Conaghan, Maurizio Cutolo, Bruno Fautrel, João Eurico Fonseca, Laure Gossec, Espen Andre Haavardsholm, Merete Lund Hetland, Annamaria Iagnocco, Pierre‐Antoine Juge, Z A Li, Rikke Helene Moe, Peter T. Nash, Gyula Poór, Andrea Rubbert‐Roth, R. Dos-Santos Sobrín, Hendrik Schulze-Koops, Russka Shumnalieva, Ladislav Šenolt, Lucía Silva-Fernández, Anja Strangfeld, Peter C. Taylor, Carl Turesson, Elsa van Duuren, Maarten de Wit, Ricardo Machado Xavier, Andreas Kerschbaumer, Robert Landewé · 发表于：Annals of the Rheumatic Diseases · 年份：2026 · DOI：10.1016/j.ard.2026.01.023 · 被引用次数：64 · 研究领域：Rheumatoid Arthritis Research and Therapies、Biosimilars and Bioanalytical Methods、Pharmacovigilance and Adverse Drug Reactions

OBJECTIVES: This study aims to provide an update of the European Alliance of Associations for Rheumatology (EULAR) rheumatoid arthritis (RA) management recommendations addressing the most recent insights. METHODS: An International Task Force was formed with a wide expertise and solicited 2 systemic literature research activities on the safety and efficacy of disease-modifying antirheumatic drugs (DMARDs). New evidence was discussed, considering the update from 2022. A voting process was applied to each item. Levels of evidence and strengths of recommendation were assigned, and participants voted on the levels of agreement. RESULTS: The task force agreed on 5 overarching principles and reduced the number of recommendations to 9 concerning use of conventional synthetic DMARDs (methotrexate [MTX], leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b)DMARDs (tumour necrosis factor inhibitors [adalimumab, certolizumab pegol, etanercept, golimumab, infliximab], abatacept, rituximab, tocilizumab, sarilumab, including biosimilars) and targeted synthetic [ts]DMARDs (namely the Janus kinase inhibitors [JAKi] tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target), and tapering following clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were considered. Initially, MTX ideally in combination...