Evidence map›Paper›PMID 24442884›Full record

Observational studyAnnals of the rheumatic diseases2015

Rituximab versus an alternative TNF inhibitor in patients with rheumatoid arthritis who failed to respond to a single previous TNF inhibitor: SWITCH-RA, a global, observational, comparative effectiveness study.

P Emery, J E Gottenberg, A Rubbert-Roth, P Sarzi-Puttini, D Choquette, V M Martínez Taboada, L Barile-Fabris, R J Moots, A Ostor, A Andrianakos and 5 more

Open access · hybridAbstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Annals of the rheumatic diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
74citing papers in PubMed, 7 pooled it
14.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

74 citing papers in PubMed, 7 syntheses or guidelines pooled it, 154 citations in OpenAlex.

  1. Pooled it
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  18. [Switching Biologics: this is how I proceed].Zeitschrift fur Rheumatologie · 2025
    Article
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  20. Article

14 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 13 institutions in 9 countries.

P EmeryLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
J E GottenbergDepartment of Rheumatology, CHU Strasbourg, Strasbourg, France.
A Rubbert-RothUniversity of Cologne, Cologne, Germany.
P Sarzi-PuttiniL Sacco University Hospital, Milan, Italy.
D ChoquetteUniversity of Montreal, Montreal, Canada.
V M Martínez TaboadaFacultad de Medicina, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
L Barile-FabrisHospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico.
R J MootsDepartment of Rheumatology, University of Liverpool, Liverpool, UK.
A OstorCambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
A AndrianakosHellenic Foundation for Rheumatological Research, Athens, Greece.
E GemmenQuintiles, Rockville, Maryland, USA.
C MpofuF Hoffmann-La Roche Ltd, Basel, Switzerland.
C ChungGenentech Inc, San Francisco, California, USA.
L Hinsch GylvinF Hoffmann-La Roche Ltd, Basel, Switzerland.
A FinckhUniversity Hospital of Geneva, Geneva, Switzerland.
Roche (Switzerland) · CHCambridge University Hospitals NHS Foundation Trust · GBChapel Allerton Hospital · GBGenentechHôpital Civil, Strasbourg · FRIQVIA (United States) · USLuigi Sacco Hospital · ITMexican Social Security Institute · MXUniversidad de Cantabria · ESUniversité de Montréal · CAUniversity Hospital of Geneva · CHUniversity of Cologne · DEUniversity of Liverpool · GB

Funding

Arthritis Research UK 18475
6 · The paper itself

Abstract

objectivesTo compare the effectiveness of rituximab versus an alternative tumour necrosis factor (TNF) inhibitor (TNFi) in patients with rheumatoid arthritis (RA) with an inadequate response to one previous TNFi.

methodsSWITCH-RA was a prospective, global, observational, real-life study. Patients non-responsive or intolerant to a single TNFi were enrolled ≤4 weeks after starting rituximab or a second TNFi. Primary end point: change in Disease Activity Score in 28 joints excluding patient's global health component (DAS28-3)-erythrocyte sedimentation rate (ESR) over 6 months.

results604 patients received rituximab, and 507 an alternative TNFi as second biological therapy. Reasons for discontinuing the first TNFi were inefficacy (n=827), intolerance (n=263) and other (n=21). A total of 728 patients were available for primary end point analysis (rituximab n=405; TNFi n=323). Baseline mean (SD) DAS28-3-ESR was higher in the rituximab than the TNFi group: 5.2 (1.2) vs 4.8 (1.3); p<0.0001. Least squares mean (SE) change in DAS28-3-ESR at 6 months was significantly greater in rituximab than TNFi patients: -1.5 (0.2) vs -1.1 (0.2); p=0.007. The difference remained significant among patients discontinuing the initial TNFi because of inefficacy (-1.7 vs -1.3; p=0.017) but not intolerance (-0.7 vs -0.7; p=0.894). Seropositive patients showed significantly greater improvements in DAS28-3-ESR with rituximab than with TNFi (-1.6 (0.3) vs -1.2 (0.3); p=0.011), particularly those switching because of inefficacy (-1.9 (0.3) vs -1.5 (0.4); p=0.021). The overall incidence of adverse events was similar between the rituximab and TNFi groups.

conclusionsThese real-life data indicate that, after discontinuation of an initial TNFi, switching to rituximab is associated with significantly improved clinical effectiveness compared with switching to a second TNFi. This difference was particularly evident in seropositive patients and in those switched because of inefficacy.

Indexed as

Adrenal Cortex HormonesAdultAgedAntibodies, Monoclonal, Murine-DerivedAntirheumatic AgentsArthritis, RheumatoidDrug SubstitutionDrug Therapy, CombinationFemaleHumansMaleMethotrexateMiddle AgedProspective StudiesRituximabTreatment FailureAdrenal Cortex HormonesAntibodies, Monoclonal, Murine-DerivedAntirheumatic AgentsMethotrexateRituximabTumor Necrosis Factor-alphaAnti-TNFB cellsDMARDs (biologic)Rheumatoid ArthritisTreatment

Identifiers

PMID24442884
PMCPMC4431330
OpenAlexW2106914983

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.