Forthcoming Updated European League Against Rheumatism Eular Management Guidelines
Eular Guidelines 2019
Eular Guidelines Rheumatoid Arthritis 2017
Process and challenges facedIn 2015, both the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and the EULAR presented updated recommendations on the management of PsA ,. New therapies, assessments and increasing evidence on comorbidities required substantial revision of treatment strategies.This editorial provides comments on the key barriers faced and how these were addressed. The challenges focus around the remit of the recommendations, the scope of the literature review and assessment of the available data. Scope, remit and presentationHeterogenity of PsAIn a heterogeneous condition such as PsA with multiple domains, should recommendations address these aspects of disease individually or attempt to create a single management strategy?Stakeholder involvementWho should be involved in the development process? Scope, remit and presentationHeterogenity of PsAIn a heterogeneous condition such as PsA with multiple domains, should recommendations address these aspects of disease individually or attempt to create a single management strategy?Stakeholder involvementWho should be involved in the development process? Scope, remit and presentationHeterogenity of PsAIn a heterogeneous condition such as PsA with multiple domains, should recommendations address these aspects of disease individually or attempt to create a single management strategy?Stakeholder involvementWho should be involved in the development process? Scope, remit and presentationHeterogenity of PsAIn a heterogeneous condition such as PsA with multiple domains, should recommendations address these aspects of disease individually or attempt to create a single management strategy?Stakeholder involvementWho should be involved in the development process?
.disease is severe (a DAS28 of more than 5.1) and.they cannot have rituximab and.the company provides baricitinib with the discount agreed in the patient access scheme.1.3 Baricitinib can be used as monotherapy for people who cannot take methotrexate because it is contraindicated or because of intolerance, when the criteria in sections 1.1 and 1.2 are met.1.4 Continue treatment only if there is a moderate response measured using European League Against Rheumatism (EULAR) criteria at 6 months after starting therapy. After an initial response within 6 months, withdraw treatment if at least a moderate EULAR response is not maintained.1.5 These recommendations are not intended to affect treatment with baricitinib that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.Why the committee made these recommendationsClinical trials showed baricitinib plus conventional disease-modifying antirheumatic drugs (DMARDs) to be more effective than conventional DMARDs alone for treating severe active rheumatoid arthritis that has not responded adequately to conventional or biological DMARDs. Some trial evidence also suggests that in people who have not previously had DMARDs, baricitinib works as well when taken alone as it does when taken with conventional DMARDs.Baricitinib plus conventional DMARDs was also shown to have similar effectiveness to the biological DMARD adalimumab in people whose disease has responded inadequately to conventional DMARDs. Because there are no trials which compare baricitinib with other biological DMARDs, the company did an indirect comparison. Baricitinib was shown to work as well as most of the biological DMARDs which NICE has already recommended in this indication.Based on the health-related benefits and costs compared with conventional and biological DMARDs, baricitinib plus conventional DMARDs was recommended as a cost-effective treatment, in line with previous recommendations in NICE technology appraisal guidance on.