title: Update on the 2012 Brazilian Society of Rheumatology Guidelines for the treatment of rheumatoid arthritis: position on the use of tofacitinib.
abstract: In 2014, tofacitinib, a target-specific, synthetic disease modifying anti rheumatic drug (DMARD) and a selective inhibitor of Janus kinase (JAK) was approved for use in Brazil. This position paper aims to update the recommendations of the Brazilian Society of Rheumatology (SBR) on the treatment of rheumatoid arthritis (RA) in Brazil, specifically regarding the use of target-specific synthetic DMARDs. The method of this recommendation consisted of a literature review of scientific papers held on the Medline database. After this review, a text was produced, answering questions in Pico structure, considering efficacy and safety issues of tofacitinib use for RA treatment in different scenarios (such as first-line treatment after failure with methotrexate [MTX] or other conventional synthetic DMARDs after failure with biological therapy). Based on existing evidence, and considering the available data on efficacy, safety and cost of medications available to treat the disease in Brazil, the RA Commission of SBR, after a process of discussion and voting on proposals, established the following position on the use of tofacitinib for treatment of RA in Brazil: "Tofacitinib, alone or in combination with MTX, is an alternative for RA patients with moderate or high activity after failure of at least two different synthetic DMARDs and one biological DMARD." The level of agreement with this recommendation was 7.5. This position may be reviewed in the coming years, in the face of a greater experience with the use of this medication.
authors.affiliation: Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, DF, Brasil; Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brasil. Electronic address: licia@unb.br.
authors.forename: Licia Maria Henrique
authors.initials: LM
authors.lastname: da Mota
authors.affiliation: Biocor Instituto, Nova Lima, MG, Brasil.
authors.forename: Bóris Afonso
authors.initials: BA
authors.lastname: Cruz
authors.affiliation: Serviço de Reumatologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, DF, Brasil.
authors.forename: Cleandro Pires
authors.initials: CP
authors.lastname: de Albuquerque
authors.affiliation: Serviço de Reumatologia, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil; Serviço de Reumatologia, Hospital Geral Dr. César Cals, Fortaleza, CE, Brasil; Programa de Residência Médica em Reumatologia, Hospital Geral Dr. César Cals, Fortaleza, CE, Brasil.
authors.forename: Deborah Pereira
authors.initials: DP
authors.lastname: Gonçalves
authors.affiliation: Universidade de São Paulo (USP), São Paulo, SP, Brasil; BiobadaBrasil, Brasil.
authors.forename: Ieda Maria Magalhães
authors.initials: IM
authors.lastname: Laurindo
authors.affiliation: Disciplina de Reumatologia, Universidade do Sul de Santa Catarina (Unisul), Florianópolis, SC, Brasil; Núcleo de Reumatologia, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil.
authors.forename: Ivanio Alves
authors.initials: IA
authors.lastname: Pereira
authors.affiliation: Hospital Aliança, Salvador, BA, Brasil.
authors.forename: Jozélio Freire
authors.initials: JF
authors.lastname: de Carvalho
authors.affiliation: Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (Uerj), Rio de Janeiro, RJ, Brasil.
authors.forename: Geraldo da Rocha Castelar
authors.initials: Gda R
authors.lastname: Pinheiro
authors.affiliation: Disciplina de Reumatologia, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; Departamento de Clínica Médica, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.
authors.forename: Manoel Barros
authors.initials: MB
authors.lastname: Bertolo
authors.affiliation: Ambulatório de Artrite Reumatoide, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil; Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil.
authors.forename: Maria Raquel da Costa
authors.initials: MR
authors.lastname: Pinto
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Louzada-Junior
authors.affiliation: Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Ricardo Machado
authors.initials: RM
authors.lastname: Xavier
authors.affiliation: Serviço de Reumatologia, Hospital do Servidor Público Estadual Francisco Morato de Oliveira (HSPE-FMO), São Paulo, SP, Brasil.
authors.forename: Rina Dalva Neubarth
authors.initials: RD
authors.lastname: Giorgi
authors.affiliation: Serviço de Reumatologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil.
authors.forename: Rodrigo Aires Corrêa
authors.initials: RA
authors.lastname: Lima
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001938:Brazil; D004359:Drug Therapy, Combination; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use*; D012219:Rheumatology; D012955:Societies, Medical; D017211:Treatment Failure
chemical_list: D018501:Antirheumatic Agents; D010880:Piperidines; D011743:Pyrimidines; D011758:Pyrroles; C479163:tofacitinib; D008727:Methotrexate
keywords: Artrite reumatoide; Brasil; Brazil; Rheumatoid arthritis; Tofacitinib; Tofacitinibe; Tratamento; Treatment