Recommendations of the French Society for Rheumatology. TNFalpha antagonist therapy in rheumatoid arthritis.
OBJECTIVE
To develop recommendations for TNFalpha-antagonist therapy in patients with rheumatoid arthritis (RA) seen in everyday practice, under the aegis of the French Society for Rheumatology.


METHODS
We used the methods recommended by the French Agency for Healthcare Accreditation and Evaluation, the AGREE collaboration, and the European League against Rheumatism (EULAR). The recommendations focus on patient selection, monitoring, and treatment adjustments.


RESULTS
Criteria for selecting patients eligible for TNFalpha-antagonist treatment of RA include: 1) a definitive diagnosis of RA; 2) disease activity for longer than 1 month, including presence of objective signs of inflammation; or radiographic progression; 3) previous failure of methotrexate in the highest tolerated dosage or of another disease-modifying antirheumatic drug in patients with contraindications to methotrexate; 4) absence of contraindications to TNFalpha-antagonist therapy. When starting TNFalpha-antagonist therapy 1) a thorough baseline evaluation should be conducted; 2) any of the three available agents can be used, as no differences in efficacy have been identified in patient populations; 3) concomitant methotrexate therapy is recommended regardless of the TNFalpha antagonist used; and 4) patients should receive standardized follow-up at regular intervals. Treatment adjustments should be based on the following: 1) the treatment objective is achievement of a EULAR response; 2) when such a response is not achieved, the dosage or dosing interval can be changed, or the patient can be switched to another TNFalpha antagonist; 3) in patients who experience intolerance to a TNFalpha antagonist, another TNFalpha antagonist may be tried, depending on the nature of the adverse event; 4) occurrence of a remission should lead to a reduction in symptomatic medications, most notably glucocorticoids where used; in the event of a prolonged remission, either the TNFalpha antagonist or the concomitant disease-modifying antirheumatic drug may be reduced.


CONCLUSIONS
These recommendations are intended to help physicians use TNFalpha antagonists in their everyday practice with RA patients. They do not constitute regulations.
Fautrel
Bruno
B
Service de Rhumatologie, Groupe Hospitalier Pitié-Salpêtrière, UFR de Médecine, Université Pierre et Marie-Curie-Paris-VI, 83, Boulevard de l'Hôpital, 75651 Paris cedex 13, France. bruno.fautrel@psl.aphp.fr
Constantin
Arnaud
A
Morel
Jacques
J
Vittecoq
Olivier
O
Cantagrel
Alain
A
Combe
Bernard
B
Dougados
Maxime
M
Le Loët
Xavier
X
Mariette
Xavier
X
Pham
Thao
T
Puéchal
Xavier
X
Sibilia
Jean
J
Soubrier
Martin
M
Ravaud
Philippe
P
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000378:metabolism*; D005602:France; D006801:Humans; D017410:Practice Guidelines as Topic; D012219:Rheumatology; D012955:Societies, Medical; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha