Observational studyRMD open2026
Real-world effectiveness of b/tsDMARD switching in low-inflammatory difficult-to-treat rheumatoid arthritis: insights from the FIRST registry.
Observational study in RMD open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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.
Who cites it
1 citing paper in PubMed.
- Emerging trends in the management of difficult-to-treat rheumatoid arthritis: targeted treatments and non-pharmacological interventions.Rheumatology (Oxford, England) · 2026Review
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the effectiveness of switching biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in patients with low-inflammatory difficult-to-treat rheumatoid arthritis (D2T RA).
methodsUsing the multicentre FIRST registry, we identified D2T RA between August 2013 and March 2024. Low-inflammatory D2T RA was defined as a swollen 28-joint count ≤1 and C-reactive protein <10 mg/L. In the low-inflammatory D2T RA group, we compared those who underwent b/tsDMARD switching (the switch group) with the non-switch group. The primary outcome was the 6-month change in Clinical Disease Activity Index (CDAI).
resultsAmong 3519 patients, 457 fulfilled the D2T RA criteria, and 173 were low-inflammatory D2T RA. Compared with inflammatory D2T RA, these patients had a shorter disease duration (127.4 vs 146.4 months), lower methotrexate (9.2 vs 10.5 mg/week) and glucocorticoid doses (4.3 vs 5.2 mg/day), and higher rates of fibromyalgia (2.9% vs 1.4%) and psychological disorders (5.2% vs 1.8%). The proportion receiving b/tsDMARD switching was lower in low-inflammatory than in inflammatory D2T RA (29/173 (16.8%) vs 217/284 (76.4%)). In the propensity score-matched analysis, the switch group (n=15) showed greater improvements in CDAI and pain than the non-switch group (n=30) (-6.6 vs -2.2, -15.3 vs -3.4, both p<0.05). Even among patients with low-grade sonographic activity (greyscale ≤1, power Doppler=0), b/tsDMARD switching improved CDAI (16.8 to 9.7).
conclusionsA subset of patients with low-inflammatory D2T RA may benefit from b/tsDMARD switching, indicating that low-inflammatory status alone should not preclude consideration of treatment intensification.
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