Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense Madrid, Madrid, Spain.
Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
Reumatol Clin (Engl Ed). 2024 Oct;20(8):423-439. doi: 10.1016/j.reumae.2024.09.002. Epub 2024 Sep 27.
To update the consensus document of the Spanish Society of Rheumatology (SER) regarding the use of targeted biological and synthetic therapies in rheumatoid arthritis (RA) with the aim of assisting clinicians in their therapeutic decisions.
A panel of 13 experts was assembled through an open call by SER. We employed a mixed adaptation-elaboration-update methodology starting from the 2015 Consensus Document of the Spanish Society of Rheumatology on the use of biological therapies in RA. Starting with systematic reviews (SR) of recommendations from EULAR 2019, American College of Rheumatology 2021, and GUIPCAR 2017, we updated the search strategies for the PICO questions of GUIPCAR. An additional SR was conducted on demyelinating disease in relation to targeted biological and synthetic therapies. Following the analysis of evidence by different panelists, consensus on the wording and level of agreement for each recommendation was reached in a face-to-face meeting.
The panel established 5 general principles and 15 recommendations on the management of RA. These encompassed crucial aspects such as the importance of early treatment, therapeutic goals in RA, monitoring frequency, the use of glucocorticoids, the application of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biological DMARDs (bDMARDs), and targeted synthetic DMARDs. Additionally, recommendations on dose reduction of these drugs in stable patients were included. This update also features recommendations on the use of bDMARDs and Janus Kinase inhibitors in some specific clinical situations, such as patients with lung disease, a history of cancer, heart failure, or demyelinating disease.
This update provides recommendations on key aspects in the management of RA using targeted biological and synthetic therapies.
更新西班牙风湿病学会（SER）关于类风湿关节炎（RA）中靶向生物和合成疗法使用的共识文件，旨在帮助临床医生做出治疗决策。
通过 SER 的公开征集，组建了一个由 13 名专家组成的小组。我们采用了混合改编-阐述-更新的方法，从 2015 年西班牙风湿病学会关于 RA 中生物疗法使用的共识文件开始。从 EULAR 2019、美国风湿病学会 2021 和 GUIPCAR 2017 的建议的系统评价（SR）开始，我们更新了 GUIPCAR 的 PICO 问题的搜索策略。另外还对脱髓鞘疾病与靶向生物和合成疗法的关系进行了 SR。在不同小组成员对证据进行分析后，在面对面会议上就每条建议的措辞和达成共识的程度达成一致。
专家组就 RA 的管理制定了 5 项一般原则和 15 项建议。这些建议涵盖了早期治疗、RA 的治疗目标、监测频率、糖皮质激素的使用、常规合成疾病修饰抗风湿药物（csDMARDs）、生物 DMARDs（bDMARDs）和靶向合成 DMARDs 的应用等重要方面。此外，还包括了稳定患者这些药物剂量减少的建议。本次更新还包括了 bDMARDs 和 Janus 激酶抑制剂在某些特定临床情况下的使用建议，如肺部疾病、癌症史、心力衰竭或脱髓鞘疾病患者。
本次更新提供了使用靶向生物和合成疗法治疗 RA 的关键方面的建议。
