somewordstoolate/Q2CRBench-3 huggingface dataset:
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to Rituximab
Outcome: Serious adverse events (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to RTX: 4/74 (5.4%)
Switch to a 2nd TNFi: 1/65 (1.5%)
Effect: Relative Effect (95% CI): RR 4.10 (0.48 to 35.11)
Absolute Effect (95% CI): 48 more per 1,000 (from 8 fewer to 525 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to Rituximab
Outcome: Withdrawal due to lack of efficacy (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to RTX: 0/40 (0.0%)
Switch to a 2nd TNFi: 2/41 (4.9%)
Effect: Relative Effect (95% CI): RR 0.20 (0.01 to 4.14)
Absolute Effect (95% CI): 39 fewer per 1,000 (from 48 fewer to 153 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to Rituximab
Outcome: Withdrawal due to adverse events (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very small sample size, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to RTX: 0/40 (0.0%)
Switch to a 2nd TNFi: 0/41 (0.0%)
Effect: Relative Effect (95% CI): not estimable
Absolute Effect (95% CI): -
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to Rituximab
Outcome: Death (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very small sample size, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to RTX: 1/40 (2.5%)
Switch to a 2nd TNFi: 0/41 (0.0%)
Effect: Relative Effect (95% CI): RR 3.07 (0.13 to 73.28)
Absolute Effect (95% CI): 0 fewer per 1,000 (from 0 fewer to 0 fewer)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to Rituximab
Outcome: CVD (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to RTX: 2/34 (5.9%)
Switch to a 2nd TNFi: 2/24 (8.3%)
Effect: Relative Effect (95% CI): RR 0.71 (0.11 to 4.67)
Absolute Effect (95% CI): 24 fewer per 1,000 (from 74 fewer to 306 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to Rituximab
Outcome: Malignancy (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very small sample size, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to RTX: 3/34 (8.8%)
Switch to a 2nd TNFi: 0/24 (0.0%)
Effect: Relative Effect (95% CI): RR 5.00 (0.27 to 92.56)
Absolute Effect (95% CI): 0 fewer per 1,000 (from 0 fewer to 0 fewer)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to IL-6 Receptor Inhibitor
Outcome: Disease activity (follow up: 6 months; assessed with: DAS 28-ESR)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Confidence interval includes both values suggesting no effect and values suggesting benefit.
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Switch to 2nd TNFi: 390
Switch to IL-6 inhibitor: 147
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 1.3 lower (1.63 lower to 0.97 lower)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to IL-6 Receptor Inhibitor
Outcome: Low disease activity (follow up: 6 months; assessed with: DAS28-ESR <3.2)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Observational Study
Certainty: LOW
No of participants: Switch to 2nd TNFi: 43/103 (41.7%)
Switch to IL-6 inhibitor: 29/44 (65.9%)
Effect: Relative Effect (95% CI): RR 0.63 (0.46 to 0.87)
Absolute Effect (95% CI): 244 fewer per 1,000 (from 356 fewer to 86 fewer)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to IL-6 Receptor Inhibitor
Outcome: Pain (follow up: 6 months; assessed with: VAS 100)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Observational Study
Certainty: LOW
No of participants: Switch to 2nd TNFi: 185
Switch to IL-6 inhibitor: 74
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 1.1 lower (7.52 lower to 5.32 higher)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to IL-6 Receptor Inhibitor
Outcome: Disability (follow up: 6 months; assessed with: HAQ-DI)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Confidence interval includes both values suggesting no effect and values suggesting benefit.
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Switch to 2nd TNFi: 185
Switch to IL-6 inhibitor: 74
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.2 lower (0.4 lower to 0)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to IL-6 Receptor Inhibitor
Outcome: Withdrawal due to adverse events (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Observational Study
Certainty: LOW
No of participants: Switch to 2nd TNFi: 49/217 (22.6%)
Switch to IL-6 inhibitor: 19/35 (54.3%)
Effect: Relative Effect (95% CI): RR 0.42 (0.28 to 0.62)
Absolute Effect (95% CI): 315 fewer per 1,000 (from 391 fewer to 206 fewer)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Switch to IL-6 Receptor Inhibitor
Outcome: Withdrawal due to lack of efficacy (follow up: 6 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Observational Study
Certainty: LOW
No of participants: Switch to 2nd TNFi: 137/217 (63.1%)
Switch to IL-6 inhibitor: 11/35 (31.4%)
Effect: Relative Effect (95% CI): RR 2.01 (1.22 to 3.31)
Absolute Effect (95% CI): 317 more per 1,000 (from 69 more to 726 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Continue same management
Outcome: Disease activity (follow up: 4 months; assessed with: ACR 20)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to serious risk of bias. Lack of blinding (except for radiographic outcomes) and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 2nd TNFi: 8/13 (61.5%)
Continue 1st TNFi: 4/14 (28.6%)
Effect: Relative Effect (95% CI): RR 2.15 (0.85 to 5.48)
Absolute Effect (95% CI): 329 more per 1,000 (from 43 fewer to 1,000 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Continue same management
Outcome: Disease activity (follow up: 4 months; assessed with: ACR 50)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to serious risk of bias. Lack of blinding (except for radiographic outcomes) and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 2nd TNFi: 4/13 (30.8%)
Continue 1st TNFi: 2/14 (14.3%)
Effect: Relative Effect (95% CI): RR 2.15 (0.47 to 9.85)
Absolute Effect (95% CI): 164 more per 1,000 (from 76 fewer to 1,000 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Continue same management
Outcome: Disease activity (follow up: 4 months; assessed with: DAS28-ESR)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to serious risk of bias. Lack of blinding (except for radiographic outcomes) and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting no effect. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 2nd TNFi: 13
Continue 1st TNFi: 14
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 1.2 lower (2.37 lower to 0.03 lower)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Continue same management
Outcome: Remission (follow up: 4 months; assessed with: DAS28-ESR <2.6)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to serious risk of bias. Lack of blinding (except for radiographic outcomes) and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very small sample size, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 2nd TNFi: 8/13 (61.5%)
Continue 1st TNFi: 2/14 (14.3%)
Effect: Relative Effect (95% CI): RR 4.31 (1.11 to 16.67)
Absolute Effect (95% CI): 473 more per 1,000 (from 16 more to 1,000 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Continue same management
Outcome: Radiographic progression (follow up: 4 months; assessed with: Sharp/ van der Heijde)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding of patients and personnel and lack of allocation concealment. Outcome assessors for radiographic outcomes were blinded.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 2nd TNFi: 12
Continue 1st TNFi: 12
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.6 higher (1.78 lower to 2.98 higher)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Continue same management
Outcome: Serious adverse events (follow up: 4 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to serious risk of bias. Lack of blinding (except for radiographic outcomes) and lack of allocation concealment.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 2nd TNFi: 0/13 (0.0%)
Continue 1st TNFi: 2/14 (14.3%)
Effect: Relative Effect (95% CI): RR 0.21 (0.01 to 4.08)
Absolute Effect (95% CI): 113 fewer per 1,000 (from 141 fewer to 440 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on their first TNF Inhibitor who are NOT at target, switch to a 2nd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their first TNF Inhibitor who are not at target
Intervention: Switch to a 2nd TNF Inhibitor
Comparator: Continue same management
Outcome: Serious adverse events (from SR of harms)

Evidence assessment:
GRADE: result_interpretation: The Systematic Review RefID=5595, 2011 comparing Infliximab vs Etanercept among RA and AS, Psoriasis, PsA, IBD, Cancer showed that for Serious adverse events, the result was OR=0.93 (0.60 to 1.42). The Systematic Review RefID=1403, 2017 comparing Infliximab vs Etanercept among RA showed that for Serious adverse events, the result was RR=4.90 (0.23 to 104) [Direct Evidence, Low certainty].
Study design: Systematic Review