This has led EULAR to recommend that if the treatment target is not achieved with the first conventional synthetic DMARD and poor prognostic factors are present, then a biologic DMARD should be added, and a targeted synthetic DMARD could be considered, but pertinent risk factors for MACE or malignancy must be taken into account.
Finally, Dr. Smolen noted the recommendations indicate that when sustained remission has been achieved, glucocorticoids are the first drug category that should be tapered, followed by biologic DMARDs, targeted synthetic DMARDs and conventional synthetic DMARDs.
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Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
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