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

Todoerti, Monica;Favalli, Ennio Giulio;Iannone, Florenzo;Olivieri, Ignazio;Benucci, Maurizio;Cauli, Alberto

Member of the Collaboration Group

;Mathieu, Alessandro

Member of the Collaboration Group

;Santo, Leonardo;Minisola, Giovanni;Lapadula, Giovanni;Bucci, Romano;Gremese, Elisa;Caporali, Roberto

2018-01-01

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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.