Monica Todoerti1, Ennio Giulio Favalli2, Florenzo Iannone3, Ignazio Olivieri4, Maurizio Benucci5, Alberto Cauli6, Alessandro Mathieu6, Leonardo Santo7, Giovanni Minisola8, Giovanni Lapadula3, Romano Bucci9, Elisa Gremese10, Roberto Caporali1. 1. Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia. 2. Department of Rheumatology, Gaetano Pini Institute, Milan. 3. Department of Emergency and Organ Transplantation (DETO), University of Bari, Section of Rheumatology, Bari. 4. Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera. Basilicata Ricerca Biomedica (BRB) Foundation, Potenza. 5. Rheumatology Unit, S. Giovanni di Dio Hospital, Florence. 6. Rheumatology Unit, University Clinic and AOU of Cagliari, Cagliari. 7. Rheumatology Service ASL BT - DSS4 Barletta. 8. Fondazione Ospedale San Camillo - Roma. 9. Reumatologia Ospedaliera, Dipartimento Internistico, A.O.U. 'OO.RR' - Foggia. 10. Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
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.
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 RApatients 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 RApatients 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 RApatients.
Authors: Karin Luttropp; Johan Dalén; Axel Svedbom; Mary Dozier; Christopher M Black; Amy Puenpatom Journal: Patient Prefer Adherence Date: 2020-02-17 Impact factor: 2.711