Chak Sing Lau1, Faith Chia2, Leonila Dans3,4, Andrew Harrison5, Tsu Yi Hsieh6, Rahul Jain7, Seung Min Jung8, Mitsumasa Kishimoto9, Ashok Kumar10, Khai Pang Leong2, Zhanguo Li11, Juan Javier Lichauco12, Worawit Louthrenoo13, Shue Fen Luo14, Rong Mu11, Peter Nash15, Chin Teck Ng16,17, Bagus Suryana18, Linda Kurniaty Wijaya19, Swan Sim Yeap20. 1. Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong. 2. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore. 3. Department of Pediatrics, University of the Philippines Manila, Manila, Philippines. 4. Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines. 5. Department of Medicine, University of Otago Wellington, Wellington, New Zealand. 6. Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan. 7. Jaipur Arthritis Centre, Jaipur, India. 8. Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 9. Immuno-Rheumatology Center, St Luke's International Hospital, St Luke's International University, Tokyo, Japan. 10. Department of Rheumatology, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India. 11. Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China. 12. Rheumatology, Allergy and Immunology Center, St. Luke's Medical Center, Quezon City, Philippines. 13. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 14. Department of Rheumatology, Allergy, Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan. 15. Department of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. 16. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. 17. Duke-NUS Medical School, Singapore, Singapore. 18. Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia. 19. Sari Asih Ciputat Hospital, South Tangerang, Indonesia. 20. Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Malaysia.
Abstract
AIM: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice. MATERIALS AND METHODS: A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique. RESULTS: This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery. CONCLUSION: Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.
AIM: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice. MATERIALS AND METHODS: A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique. RESULTS: This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery. CONCLUSION:Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.