SynthesisClinical rheumatology2025
The role of sequential biologic therapy in rheumatoid arthritis: a systematic review and meta-analysis of efficacy, safety, and predictive factors.
Synthesis in Clinical rheumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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.
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
2 citing papers in PubMed.
- Article
- Remission and treatment persistence during sequential therapy in rheumatoid arthritis: results from the Estonian Biologic Treatment Registry.Rheumatology international · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBiologic DMARDs have revolutionized rheumatoid arthritis (RA) management; however, therapeutic switching is often required due to inefficacy or intolerance. This study aimed to systematically evaluate the efficacy, safety, and predictive factors of response to sequential bDMARD therapy in adult RA patients.
methodsA systematic review and meta-analysis were conducted following PRISMA 2020 guidelines (PROSPERO ID: CRD42025632894). PubMed, Scopus, Web of Science, and Cochrane Library were searched through March 2025. Eligible studies included RCTs and observational cohorts assessing outcomes after switching between bDMARDs. Primary outcomes included clinical efficacy (ACR20/50/70, DAS28, CDAI), safety (adverse events [AEs], serious adverse events [SAEs]), and predictors of therapeutic response. Risk of bias was evaluated using ROB2 and ROBINS-I tools; certainty of evidence was assessed with GRADE. Meta-analyses were performed using random-effects models.
resultsFifty-seven studies (n > 620,000) were included. Sequential bDMARD use was primarily driven by secondary inefficacy or adverse events. Fifteen studies (n = 11,066) were included in the meta-analysis. Pooled data revealed superior ACR50 response rates in patients receiving b/tsDMARDs compared to controls (RR = 1.89; 95% CI: 1.37-2.61; p < 0.00001), despite high heterogeneity (I
conclusionSequential bDMARD therapy is effective and safe in RA patients requiring a therapeutic switch. Inter-class transitions, particularly following TNF inhibitor failure, may enhance outcomes. Identifying predictors of response underscores the role of personalized treatment strategies in optimizing long-term RA management.
Indexed as
Identifiers
40932574What Socratic holds
Registered trials
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 Socratic graph.