Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Randomised-controlled Trial of Switching to Alternative Tumour-necrosis Factor (TNF)-Blocking Drugs or Abatacept or Rituximab in Patients With Rheumatoid Arthritis Who Have Failed an Initial TNF-blocking Drug
Brief Summary: The principal aim of this study is to fill a clear knowledge gap and provide guidance for rheumatologists and reassurance to the patient group on a management challenge faced daily in rheumatology practice. Specifically, it aims to provide robust evidence on the optimal management of patients with established RA that have failed an anti-TNF therapy (the first of the biological therapies to be introduced); in particular, the investigators wish to address whether the currently licensed but non NICE-approved treatment options, TNF-blocking drug or abatacept, are equivalent to the NICE-approved treatment, rituximab. If so, the intention is to broaden treatment options and target these specific therapies to disease sub-groups.


Options:
A: Arm Label: 5mg; Type: EXPERIMENTAL; Interventions: Drug: CP 690,550 | Arm Label: 10 mg; Type: EXPERIMENTAL; Interventions: Drug: CP-690,550 | Arm Label: Placebo Sequence 1; Type: PLACEBO_COMPARATOR; Interventions: Other: Placebo | Arm Label: Placebo Sequence 2; Type: PLACEBO_COMPARATOR; Interventions: Other: Placebo | Arm Label: adalimumab; Type: ACTIVE_COMPARATOR; Interventions: Biological: Biologic TNFi | Intervention Type: DRUG; Name: CP 690,550; Assigned to Arm(s): 5mg | Intervention Type: DRUG; Name: CP-690,550; Assigned to Arm(s): 10 mg | Intervention Type: OTHER; Name: Placebo; Assigned to Arm(s): Placebo Sequence 1 | Intervention Type: OTHER; Name: Placebo; Assigned to Arm(s): Placebo Sequence 2 | Intervention Type: BIOLOGICAL; Name: Biologic TNFi; Assigned to Arm(s): adalimumab
B: Arm Label: Abatacept; Type: EXPERIMENTAL; Interventions: Drug: Abatacept | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: Abatacept; Assigned to Arm(s): Abatacept | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): Placebo
C: Arm Label: Certolizumab pegol 400 mg and placebo; Type: ACTIVE_COMPARATOR; Interventions: Drug: Certolizumab pegol, Other: Placebo | Arm Label: Certolizumab pegol 200 mg and placebo; Type: EXPERIMENTAL; Interventions: Drug: Certolizumab pegol, Other: Placebo | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Other: Placebo | Intervention Type: DRUG; Name: Certolizumab pegol; Assigned to Arm(s): Certolizumab pegol 400 mg and placebo | Intervention Type: DRUG; Name: Certolizumab pegol; Assigned to Arm(s): Certolizumab pegol 200 mg and placebo | Intervention Type: OTHER; Name: Placebo; Assigned to Arm(s): Certolizumab pegol 200 mg and placebo, Certolizumab pegol 400 mg and placebo, Placebo
D: Arm Label: TNF-blocking drug; Type: EXPERIMENTAL; Interventions: Drug: Etanercept, Drug: Adalimumab, Drug: Certolizumab Pegol, Drug: Infliximab, Drug: Golimumab | Arm Label: Abatacept; Type: EXPERIMENTAL; Interventions: Drug: Abatacept | Arm Label: Rituximab; Type: ACTIVE_COMPARATOR; Interventions: Biological: Rituximab | Intervention Type: DRUG; Name: Etanercept; Assigned to Arm(s): TNF-blocking drug | Intervention Type: DRUG; Name: Abatacept; Assigned to Arm(s): Abatacept | Intervention Type: BIOLOGICAL; Name: Rituximab; Assigned to Arm(s): Rituximab | Intervention Type: DRUG; Name: Adalimumab; Assigned to Arm(s): TNF-blocking drug | Intervention Type: DRUG; Name: Certolizumab Pegol; Assigned to Arm(s): TNF-blocking drug | Intervention Type: DRUG; Name: Infliximab; Assigned to Arm(s): TNF-blocking drug | Intervention Type: DRUG; Name: Golimumab; Assigned to Arm(s): TNF-blocking drug

Answer: D