TY - JOUR
T1 - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs
T2 - 2025 update
AU - Smolen, Josef S.
AU - Edwards, Christopher J.
AU - Konzett, Victoria
AU - Laskou, Faidra
AU - Aletaha, Daniel
AU - Caporali, Roberto
AU - Dörner, Thomas
AU - Hyrich, Kimme L.
AU - Mateus, Elsa
AU - Pope, Janet E.
AU - Primdahl, Jette
AU - de Souza, Savia
AU - Stamm, Tanja
AU - Takeuchi, Tsutomu
AU - van der Heijde, D. sirée
AU - Verschueren, Patrick
AU - Winthrop, Kevin L.
AU - Alvaro-Gracia, Jose Maria
AU - Askling, Johan
AU - Bathon, Joan
AU - Buch, Maya H.
AU - Burmester, Gerd R.
AU - Codreanu, Catalin
AU - Conaghan, Philip G.
AU - Cutolo, Maurizio
AU - Fautrel, Bruno
AU - Fonseca, Joao
AU - Gossec, Laure
AU - Haavardsholm, Espen
AU - Hetland, Merete Lund
AU - Iagnocco, Annamaria
AU - Juge, Pierre-Antonie
AU - Li, Zhanguo
AU - Moe, Rikke Helene
AU - Nash, Peter
AU - Poór, Gyula
AU - Rubbert-Roth, Andrea
AU - Sobrin, Raquel dos Santos
AU - Schulze-Koops, Hendrik
AU - Shumnalieva, Russka
AU - Senolt, Ladislav
AU - Silva-Fernandez, Lucia
AU - Strangfeld, Anja
AU - Taylor, Peter
AU - Turesson, Carl
AU - van Duuren, Elsa
AU - de Wit, Maarten
AU - Xavier, Ricardo
AU - Kerschbaumer, Andreas
AU - Landewé, Robert B. M.
N1 - Publisher Copyright:
© 2026 The Authors. Published by Elsevier B.V. on behalf of European Alliance of Associations for Rheumatology (EULAR). This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/
PY - 2026/6
Y1 - 2026/6
N2 - 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 with short-term GCs is recommended; upon insufficient response after 3 to 6 months, a bDMARD should be added; after careful consideration of risks, including MACEs, malignancies and/or thrombo-embolic events, JAKi may also be considered. If the first bDMARD (or JAKi) fails, any other bDMARD (from another or the same class) or JAKi (considering risks) is recommended. With sustained remission, DMARDs may be tapered, but caution is required as stopping often leads to a flare. Levels of evidence and levels of agreement were high for most recommendations. Conclusions: These updated EULAR recommendations provide consensus on RA management based on currently available evidence regarding efficacy, safety, and cost.
AB - 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 with short-term GCs is recommended; upon insufficient response after 3 to 6 months, a bDMARD should be added; after careful consideration of risks, including MACEs, malignancies and/or thrombo-embolic events, JAKi may also be considered. If the first bDMARD (or JAKi) fails, any other bDMARD (from another or the same class) or JAKi (considering risks) is recommended. With sustained remission, DMARDs may be tapered, but caution is required as stopping often leads to a flare. Levels of evidence and levels of agreement were high for most recommendations. Conclusions: These updated EULAR recommendations provide consensus on RA management based on currently available evidence regarding efficacy, safety, and cost.
UR - https://www.scopus.com/pages/publications/105035640585
U2 - 10.1016/j.ard.2026.01.023
DO - 10.1016/j.ard.2026.01.023
M3 - Article
C2 - 41826212
SN - 0003-4967
VL - 85
SP - 991
EP - 1009
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 6
ER -