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: Intervention Type: DRUG; Name: Etanercept; Assigned to Arm(s): N/A
B: Arm Label: Abatacept (ABA) + Methotrexate (MTX) (double-blind [DB]); Type: ACTIVE_COMPARATOR; Interventions: Drug: Abatacept (ABA) + Methotrexate (MTX), double-blind (DB) | Arm Label: Infliximab + MTX (DB); Type: ACTIVE_COMPARATOR; Interventions: Drug: Infliximab (INF) + MTX, DB | Arm Label: Placebo + MTX (DB); Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo (PLA) + MTX, DB | Arm Label: Placebo + MTX switched to abatacept + MTX (DB); Type: EXPERIMENTAL; Interventions: Drug: PLA + MTX switched to ABA+ MTX, DB | Arm Label: Abatacept (open-label); Type: EXPERIMENTAL; Interventions: Drug: ABA, open-label (OL) | Intervention Type: DRUG; Name: Abatacept (ABA) + Methotrexate (MTX), double-blind (DB); Assigned to Arm(s): Abatacept (ABA) + Methotrexate (MTX) (double-blind [DB]) | Intervention Type: DRUG; Name: Infliximab (INF) + MTX, DB; Assigned to Arm(s): Infliximab + MTX (DB) | Intervention Type: DRUG; Name: Placebo (PLA) + MTX, DB; Assigned to Arm(s): Placebo + MTX (DB) | Intervention Type: DRUG; Name: PLA + MTX switched to ABA+ MTX, DB; Assigned to Arm(s): Placebo + MTX switched to abatacept + MTX (DB) | Intervention Type: DRUG; Name: ABA, open-label (OL); Assigned to Arm(s): Abatacept (open-label)
C: Arm Label: Phase 1 Etanercept + methotrexate; Type: EXPERIMENTAL; Interventions: Biological: Phase 1: Etanercept, Drug: Phase 1: Methotrexate, Drug: Phase 2: Optional ETN, SSZ, HCQ, MTX | Arm Label: Phase 1 Conventional DMARD (SSZ or HCQ) + MTX; Type: ACTIVE_COMPARATOR; Interventions: Drug: Phase 1: Methotrexate, Drug: Phase 1: Conventiaonal DMARD | Intervention Type: BIOLOGICAL; Name: Phase 1: Etanercept; Assigned to Arm(s): Phase 1 Etanercept + methotrexate | Intervention Type: DRUG; Name: Phase 1: Methotrexate; Assigned to Arm(s): Phase 1 Etanercept + methotrexate | Intervention Type: DRUG; Name: Phase 2: Optional ETN, SSZ, HCQ, MTX; Assigned to Arm(s): Phase 1 Etanercept + methotrexate | Intervention Type: DRUG; Name: Phase 1: Methotrexate; Assigned to Arm(s): Phase 1 Conventional DMARD (SSZ or HCQ) + MTX | Intervention Type: DRUG; Name: Phase 1: Conventiaonal DMARD; Assigned to Arm(s): Phase 1 Conventional DMARD (SSZ or HCQ) + MTX
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