Study: NCT01295151

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Etanercept
Description: Etanercept will be administered at a dose of 50mg by subcutaneous injection per week for a total of 12 weeks. Further treatment will be prescribed at the discretion of the treating clinician.~The patient will be taught how to administer the subcutaneous injection and injections will be monitored by the hospital until the patient is proficient with the technique.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Abatacept
Description: Abatacept will be administered at a dose determined by body weight:~Body Weight (kg) Dose (mg) \< 60kg = 500 mg~\> or equal to 60kg and \< or equal to 100kg = 750 mg \> 100 kg = 1000mg~The intravenous infusions will be administered in clinic on days 1, 15, 29 and every 28 days thereafter for a minimum of 24 weeks. Further treatment will be prescribed at the discretion of the treating clinician.

Intervention type: BIOLOGICAL
Group type: ACTIVE_COMPARATOR
Intervention: Rituximab
Description: Rituximab will be given at a dose of 1000mg; 2 intravenous infusions will be administered at days 0 (week 0) and 15 (week 2).~In line with standard practice, a patient who loses an initial response with a DAS28 increase of at least 0.6 may receive a further cycle of rituximab at the discretion of the treating clinician.~Prior to receiving rituximab, intravenous methylprednisolone 100mg will also be given.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Adalimumab
Description: Adalimumab will be given at a dose of 40mg by subcutaneous injection every two weeks for a minimum of 12 weeks. Further treatment will be prescribed at the discretion of the treating clinician.~The patient will be taught how to administer the subcutaneous injection and injections will be monitored by the hospital until the patient is proficient with the technique.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Certolizumab Pegol
Description: Certolizumab Pegol will be given at a dose of 400mg by subcutaneous injection at weeks 0, 2, 4and then at a dose of 200mg every two weeks thereafter for a minimum of 12 weeks. Further treatment will be prescribed at the discretion of the treating clinician.~The patient will be taught how to administer the subcutaneous injection and injections will be monitored by the hospital until the patient is proficient with the technique.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Infliximab
Description: Infliximab will be given at a dose of 3mg/kg per intravenous infusion in clinic.~The intravenous infusions will be administered at week 0, 2, 6 and then 8-weekly thereafter for a minimum of 12 weeks.~Further treatment will be prescribed at the discretion of the treating clinician.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Golimumab
Description: Golimumab will be given at a dose of 50mg by subcutaneous injection every 4 weeks for a minimum of 24 weeks.~Further treatment will be prescribed in line with the study protocol and following week 48, at the discretion of the treating clinician.~The participant will be taught how to administer the subcutaneous injection and injections will be monitored according to local arrangements until the participant is proficient with the technique according to local practice.