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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Fatigue (follow up: range 9 months to 12 months; assessed with: FACIT-F)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
rationales: I2=16%
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: HIGH
No of participants: Taper off DMARDs: 264
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 262
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 3.19 higher (1.53 higher to 4.85 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Quality of Life (follow up: 9 months; assessed with: SF-36 PCS)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Risk of bias associated with missing data and selective outcome reporting
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: CI includes both values suggesting benefit and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Taper off DMARDs: 63
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 65
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 2.3 higher (0.47 lower to 5.07 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Quality of Life (follow up: 9 months; assessed with: SF-36 MCS)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Risk of bias associated with missing data and selective outcome reporting
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: CI includes both values suggesting benefit and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Taper off DMARDs: 63
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 65
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 1.8 higher (0.97 lower to 4.57 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Disability (follow up: 12 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: CI includes both values suggesting benefit and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Taper off DMARDs: 201
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 197
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.2 lower (0.31 lower to 0.09 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Pain (follow up: 12 months; assessed with: VAS Pain)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: CI includes both values suggesting benefit and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Taper off DMARDs: 201
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 197
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 12.6 lower (17.05 lower to 8.15 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Withdrawal due to lack of efficacy (follow up: 12 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: Small number of events
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Taper off DMARDs: 11/202 (5.4%)
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 43/200 (21.5%)
Effect: Relative Effect (95% CI): RR 0.25 (0.13 to 0.48)
Absolute Effect (95% CI): 161 fewer per 1,000 (from 187 fewer to 112 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Withdrawal due to adverse events (follow up: range 9 months to 12 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Small number of events
CI includes both values suggesting benefit and values suggesting harm
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Taper off DMARDs: 4/267 (1.5%)
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 6/265 (2.3%)
Effect: Relative Effect (95% CI): RR 0.69 (0.21 to 2.26)
Absolute Effect (95% CI): 7 fewer per 1,000 (from 18 fewer to 29 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Serious adverse events (follow up: range 9 months to 12 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Small number of events
CI includes both values suggesting benefit and values suggesting harm
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Taper off DMARDs: 9/267 (3.4%)
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 17/265 (6.4%)
Effect: Relative Effect (95% CI): RR 0.53 (0.24 to 1.16)
Absolute Effect (95% CI): 30 fewer per 1,000 (from 49 fewer to 10 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Malignancy (follow up: range 9 months to 12 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Small number of events
CI includes both values suggesting harm and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Taper off DMARDs: 4/267 (1.5%)
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 1/265 (0.4%)
Effect: Relative Effect (95% CI): RR 3.96 (0.45 to 35.12)
Absolute Effect (95% CI): 11 more per 1,000 (from 2 fewer to 129 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD)
Outcome: Death (follow up: 12 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Small number of events
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Taper off DMARDs: 0/202 (0.0%)
Abruptly withdraw DMARDs (as long as the patient remains on at least one DMARD): 0/200 (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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Disease activity (follow up: 1 year; assessed with: DAS28-ESR)
Importance: CRITICAL

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: Randomized Controlled Trial
Certainty: HIGH
No of participants: Continue DMARDs at same doses: 200
Taper off DMARDs: 201
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.1 lower (0.31 lower to 0.11 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Flare (follow up: range 11 months to 18 months)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded for risk of bias associated with lack of blinding of participants, providers and outcome assessors
Downgraded for risk of bias associated with lack of allocation concealment
Inconsistency: result: SERIOUS
rationales: Downgraded by one level due to serious inconsistency. I2= 77%
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue DMARDs at same doses: 82 participants
Taper off DMARDs: 148 participants(69.9%)
Effect: Relative Effect (95% CI): HR 0.46 (0.31 to 0.67)
Absolute Effect (95% CI): 275 fewer per 1,000 (from 388 fewer to 146 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Radiographic progression (follow up: 1 year; assessed with: mTSS)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: CI includes both values suggesting benefit and values suggesting harm
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue DMARDs at same doses: 184
Taper off DMARDs: 184
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 3.7 higher (8.42 lower to 15.82 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Fatigue (follow up: 1 year; assessed with: FACIT-F)
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: Randomized Controlled Trial
Certainty: HIGH
No of participants: Continue DMARDs at same doses: 201
Taper off DMARDs: 201
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.1 higher (1.63 lower to 1.83 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Pain (follow up: 1 year; assessed with: VAS pain (0-100))
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: Randomized Controlled Trial
Certainty: HIGH
No of participants: Continue DMARDs at same doses: 200
Taper off DMARDs: 201
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 2.8 lower (6.6 lower to 1 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Disability (follow up: 1 year; 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: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: HIGH
No of participants: Continue DMARDs at same doses: 201
Taper off DMARDs: 201
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.1 lower (0.2 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Withdrawal due to lack of efficacy (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: VERY_SERIOUS
rationales: CI includes both values suggesting benefit and values suggesting harm
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue DMARDs at same doses: 4/202 (2.0%)
Taper off DMARDs: 11/202 (5.4%)
Effect: Relative Effect (95% CI): RR 0.36 (0.12 to 1.12)
Absolute Effect (95% CI): 35 fewer per 1,000 (from 48 fewer to 7 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
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: VERY_SERIOUS
rationales: Small number of events
CI includes both values suggesting harm and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue DMARDs at same doses: 7/202 (3.5%)
Taper off DMARDs: 4/202 (2.0%)
Effect: Relative Effect (95% CI): RR 1.75 (0.52 to 5.89)
Absolute Effect (95% CI): 15 more per 1,000 (from 10 fewer to 97 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Serious 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: VERY_SERIOUS
rationales: Small number of events
CI includes both values suggesting harm and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue DMARDs at same doses: 12/202 (5.9%)
Taper off DMARDs: 7/202 (3.5%)
Effect: Relative Effect (95% CI): RR 1.71 (0.69 to 4.27)
Absolute Effect (95% CI): 25 more per 1,000 (from 11 fewer to 113 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 DMARDs who are in low disease activity
Intervention: Taper off DMARDs (as long as the patient remains on at least one DMARD)
Comparator: Continue DMARDs at same doses
Outcome: Malignancy (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: VERY_SERIOUS
rationales: Small number of events
CI includes both values suggesting benefit and values suggesting harm
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue DMARDs at same doses: 2/202 (1.0%)
Taper off DMARDs: 4/202 (2.0%)
Effect: Relative Effect (95% CI): RR 0.50 (0.09 to 2.70)
Absolute Effect (95% CI): 10 fewer per 1,000 (from 18 fewer to 34 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio