title: Efficacy of glucocorticoids, conventional and targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis.
abstract: OBJECTIVE
  To perform a systematic literature review (SLR) informing the 2016 update of the recommendations for the management of rheumatoid arthritis (RA).
  
  
  METHODS
  An SLR for the period between 2013 and 2016 was undertaken to assess the efficacy of glucocorticoids (GCs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) (tofacitinib and baricitinib) in randomised clinical trials.
  
  
  RESULTS
  For GCs, four studies were included in the SLR. Patients without poor prognostic factors experienced benefit when GCs were added to methotrexate (MTX). Lower doses of GCs were similar to higher doses. For csDMARDs, two new studies comparing MTX monotherapy with combination csDMARD were included in the SLR. In the tREACH trial at the end of 12 months no difference between the groups in disease activity, functional ability and radiographic progression was seen, using principles of tight control (treat-to-target). In the CareRA trial, combination therapy with csDMARDs was not superior to MTX monotherapy and monotherapy was better tolerated.For tsDMARDs, tofacitinib and baricitinib were shown to be more effective than placebo (MTX) in different patient populations.
  
  
  CONCLUSIONS
  Addition of GCs to csDMARD therapy may be beneficial but the benefits should be balanced against the risk of toxicity. Under tight control conditions MTX monotherapy is not less effective than combination csDMARDs, but better tolerated. Tofacitinib and baricitinib are efficacious in patients with RA, including those with refractory disease.
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: Katerina
authors.initials: K
authors.lastname: Chatzidionysiou
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: Sharzad
authors.initials: S
authors.lastname: Emamikia
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Nam
authors.affiliation: LUMC, Leiden, The Netherlands.
authors.forename: Sofia
authors.identifier: http://orcid.org/0000-0002-8899-9087
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Smolen
authors.affiliation: LUMC, Leiden, The Netherlands.
authors.forename: Désirée
authors.identifier: http://orcid.org/0000-0002-5781-158X
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Paris Descartes University, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Utrecht University Medical Center, Utrecht, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bijlsma
authors.affiliation: Charité University Hospital, Berlin, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Burmester
authors.affiliation: Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.|EULAR Standing Committee of People with Arthritis/Rheumatism in Europe.
authors.forename: Marieke
authors.initials: M
authors.lastname: Scholte
authors.affiliation: Karolinska Institute, Stockholm, Sweden.|Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
authors.forename: Ronald
authors.initials: R
authors.lastname: van Vollenhoven
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001384:Azetidines / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011687:Purines; D011720:Pyrazoles; D011743:Pyrimidines / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides / Q000627:therapeutic use
chemical_list: D018501:Antirheumatic Agents; D001384:Azetidines; D005938:Glucocorticoids; D010880:Piperidines; D011687:Purines; D011720:Pyrazoles; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; C479163:tofacitinib; C000596027:baricitinib; D008727:Methotrexate
keywords: Corticosteroids; DMARDs (synthetic); Rheumatoid Arthritis; Treatment