ReviewClinical rheumatology2026
Choosing the next option: a scenario-based roadmap for b/tsDMARD sequencing in rheumatoid arthritis.
Review in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBiologic (b) and targeted synthetic (ts) DMARDs have expanded rheumatoid arthritis (RA) treatment options, but evidence guiding sequencing after b/tsDMARD failure remains heterogeneous and difficult to translate into clinical practice.
objectiveTo provide a pragmatic, scenario-based synthesis to guide next-therapy choice in RA after discontinuation of a b/tsDMARD.
methodsWe performed a narrative review based on PubMed and Cochrane Library searches (2010-June 2025), including systematic reviews, meta-analyses, randomised controlled trials (RCTs), and real-world studies in adults with RA after ≥ 1 failed targeted therapy. Evidence was organised into predefined clinical scenarios by number and mechanism of prior b/tsDMARD failures and synthesised using a structured framework incorporating study design, consistency, and key limitations.
resultsAcross scenarios, switching to a drug with other mechanism of action (OMA) or a JAK inhibitor (JAKi) generally showed comparable, and sometimes favourable, effectiveness and persistence versus within-class cycling, particularly after failure of multiple targeted therapies. After first TNF inhibitor (TNFi) failure, both strategies are effective, although most RCTs and observational data tend to favour switching, mainly for persistence. In more treatment-experienced RA, IL-6 inhibitors and JAKi often showed favourable effectiveness and retention, although results were inconsistent. After JAKi failure, limited and largely observational evidence suggests that cycling to a second JAKi may offer higher persistence than switching to a bDMARD.
conclusionsThis scenario-based synthesis may offer a useful complement to existing RA recommendations, potentially supporting clinicians in treatment sequencing decisions following b/tsDMARD failure, though further validation in real-world settings would help confirm its applicability.
Indexed as
Identifiers
What 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.