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: Continue same management
Outcome: Withdrawal due to 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: 2/13 (15.4%)
Continue 1st TNFi: 1/14 (7.1%)
Effect: Relative Effect (95% CI): RR 2.15 (0.22 to 21.03)
Absolute Effect (95% CI): 82 more per 1,000 (from 56 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Disease activity (follow up: 1 year; assessed with: ACR 20)
Importance: CRITICAL

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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
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 ABA: 11/31 (35.5%)
switch to a 3rd TNFi: 17/31 (54.8%)
Effect: Relative Effect (95% CI): RR 0.65 (0.37 to 1.15)
Absolute Effect (95% CI): 192 fewer per 1,000 (from 345 fewer to 82 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Disease activity (follow up: 1 year; assessed with: ACR 50)
Importance: CRITICAL

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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
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 ABA: 6/32 (18.8%)
switch to a 3rd TNFi: 9/31 (29.0%)
Effect: Relative Effect (95% CI): RR 0.65 (0.26 to 1.60)
Absolute Effect (95% CI): 102 fewer per 1,000 (from 215 fewer to 174 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Disease activity (follow up: 1 year; assessed with: ACR 70)
Importance: CRITICAL

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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
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 ABA: 3/32 (9.4%)
switch to a 3rd TNFi: 5/31 (16.1%)
Effect: Relative Effect (95% CI): RR 0.58 (0.15 to 2.23)
Absolute Effect (95% CI): 68 fewer per 1,000 (from 137 fewer to 198 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Remission (follow up: 1 year; assessed with: DAS28-ESR <2.6)
Importance: CRITICAL

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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
Imprecision: result: SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. 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 ABA: 6/76 (7.9%)
switch to a 3rd TNFi: 17/80 (21.3%)
Effect: Relative Effect (95% CI): RR 0.38 (0.16 to 0.91)
Absolute Effect (95% CI): 132 fewer per 1,000 (from 179 fewer to 19 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Disease activity (follow up: 1 year; assessed with: DAS28-ESR (Lower values – > benefit) (MCID -1.17)
Importance: CRITICAL

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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to ABA: 76
switch to a 3rd TNFi: 80
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.45 higher (0.02 higher to 0.88 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Disability (follow up: 1 year; assessed with: HAQ-DI (Lower values – > benefit) (MCID -0.22)
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting no effect and values suggesting harm. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to ABA: 77
switch to a 3rd TNFi: 81
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.04 higher (0.17 lower to 0.25 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Quality of life (follow up: 1 year; assessed with: RAQol (Lower values – > benefit) (MCID 2)
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
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 ABA: 34
switch to a 3rd TNFi: 30
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 1.5 lower (6.36 lower to 3.36 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Pain (follow up: 1 year; assessed with: VAS 0-100 (Lower values – > benefit) (MCID -11.9)
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
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 ABA: 34
switch to a 3rd TNFi: 31
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 2.5 higher (14.99 lower to 19.99 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting no effect 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 ABA: 5/63 (7.9%)
switch to a 3rd TNFi: 1/65 (1.5%)
Effect: Relative Effect (95% CI): RR 3.75 (0.64 to 22.11)
Absolute Effect (95% CI): 42 more per 1,000 (from 6 fewer to 325 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
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 ABA: 3/41 (7.3%)
switch to a 3rd TNFi: 2/41 (4.9%)
Effect: Relative Effect (95% CI): RR 1.50 (0.26 to 8.51)
Absolute Effect (95% CI): 24 more per 1,000 (from 36 fewer to 366 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. 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 ABA: 1/41 (2.4%)
switch to a 3rd TNFi: 0/41 (0.0%)
Effect: Relative Effect (95% CI): RR 3.00 (0.13 to 71.56)
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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. 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 ABA: 1/41 (2.4%)
switch to a 3rd TNFi: 0/41 (0.0%)
Effect: Relative Effect (95% CI): RR 3.00 (0.13 to 71.56)
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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. 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 ABA: 0/22 (0.0%)
switch to a 3rd TNFi: 0/24 (0.0%)
Effect: Relative Effect (95% CI): not estimable
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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Cardiovascular disease (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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on their first TNF Inhibitor who are NOT at target and the intervention is second TNFi rather than third TNFi.
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 ABA: 1/22 (4.5%)
switch to a 3rd TNFi: 2/24 (8.3%)
Effect: Relative Effect (95% CI): RR 0.55 (0.05 to 5.60)
Absolute Effect (95% CI): 37 fewer per 1,000 (from 79 fewer to 383 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 2nd TNF Inhibitor who are NOT at target, switch to a 3rd TNF Inhibitor or switch to a boDMARD targeting a different molecule or to a tsDMARD?
Population: Patients with RA on their 2nd TNF Inhibitor who are not at target
Intervention: Switch to a 3rd TNF Inhibitor
Comparator: Switch to Abatacept
Outcome: Serious adverse events (from SR of harms)

Evidence assessment:
GRADE: result_interpretation: The Systematic Review RefID=1403, 2017 comparing Rituximab vs Etanercept, Adalimumab, Certolizumab, Golimumab, and Infliximab among RA showed that for Serious adverse events, the result was RR=1.13 (0.79 to 1.62) [Low certainty], RR=1.24 (0.89 to 1.73) [Low certainty], RR=1.56 (1.03 to 2.37) [Moderate certainty], RR=1.15 (0.71 to 1.86) [Very low certainty], and RR=1.20 (0.082 to 1.74) [Low certainty] respectively. All are Indirect evidence.
Study design: Systematic Review