8
Treatment
Table 6. Specific Patient Populations
Recommendations
Certainty of
Evidence
Heart Failure
For patients with NYHA class III or IV heart failure and an
inadequate response to csDMARDs, addition of a non-TNF
inhibitor bDMARD or tsDMARD is conditionally recommended
over addition of a TNF inhibitor.
Very low
For patients taking a TNF inhibitor who develop heart failure,
a switch to a non-TNF inhibitor bDMARD or tsDMARD is
conditionally recommended over continuation of a TNF inhibitor.
Very low
Lymphoproliferative Disorder
For patients with a previous lymphoproliferative disorder for which
rituximab is an approved treatment who have moderate to high
disease activity, rituximab is conditionally recommended over other
DMARDs.
Very low
Hepatitis B
For patients initiating rituximab who are hepatitis B core antibody
positive (regardless of hepatitis B surface antigen status), prophylactic
anti-viral therapy is strongly recommended over frequent
monitoring alone.
Very low
For patients initiating any bDMARD or tsDMARD who are
hepatitis B core antibody positive and hepatitis B surface antigen
positive, prophylactic anti-viral therapy is strongly recommended
over frequent monitoring alone.
Very low
For patients initiating a bDMARD other than rituximab or
a tsDMARD who are hepatitis B core antibody positive and
hepatitis B surface antigen negative, frequent monitoring alone is
conditionally recommended over prophylactic anti-viral therapy.
Very low
Nonalcoholic Fatty Liver Disease (NAFLD)
For DMARD naïve patients with NAFLD, normal liver enzymes
and liver function tests and no evidence of advanced liver fibrosis,
who have moderate to high disease activity, methotrexate is
conditionally recommended over alternative DMARDs.
Very low
(cont'd)
