Switch or swap strategy in rheumatoid arthritis patients failing TNF inhibitors? Results of a modified Italian Expert Consensus

Monica Todoerti, Ennio Giulio Favalli, Florenzo Iannone, Ignazio Olivieri, Maurizio Benucci, Alberto Cauli, Alessandro Mathieu, Leonardo Santo, Giovanni Minisola, Giovanni Lapadula, Romano Bucci, Elisa Gremese, Roberto Caporali

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To establish evidence-based and experts' opinion filtered statements on the optimal treatment choice between cycling (switch) and changing mode of action strategies (swap) in RA patients failing TNF inhibitors (TNFis).

Methods: The relevant question (switch vs swap) was rephrased into a research question according to the population, intervention, comparison and outcome (PICO) strategy, considering all the available scientific evidence published from the 2013 EULAR set of recommendations up to mid-January 2016. Final statements derived from the retrieved scientific evidence and experts' consensus, with eventual rephrasing through a Delphi method during a national consensus of Italian rheumatologists.

Results: From a total of 365 records, 12 studies were finally included. The final statements argued that, until head-to-head comparison data are available, switch and swap can be still considered suitable strategies in RA patients failing first TNFi, even though some data seem to lend more support to a different mode of action-targeted strategy.

Conclusion: After failure of first TNFi course, switch and swap can be currently considered as alternative suitable approaches in RA patients.

Original languageEnglish
Pages (from-to)vii42-vii53
JournalRheumatology (Oxford, England)
Volume57
Issue number7
DOIs
Publication statusPublished - Oct 1 2018
Externally publishedYes

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

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