somewordstoolate/Q2CRBench-3 huggingface dataset:
Guideline: 2021 ACR RA
Clinical question: Should patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity receive MTX monotherapy or boDMARD monotherapy or tsDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity
Intervention: MTX monotherapy
Comparator: JAK Inhibitor
Outcome: Disability (follow up: 2 years; assessed with: HAQ-DI (Lower values – > benefit) (MCID -0.22)
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 benefit and values suggesting no effect.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: JAKi (Tofa): 373
MTX monotherapy: 186
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 MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity receive MTX monotherapy or boDMARD monotherapy or tsDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity
Intervention: MTX monotherapy
Comparator: JAK Inhibitor
Outcome: Serious adverse events (follow up: 2 years)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
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.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: JAKi (Tofa): 40/373 (10.7%)
MTX monotherapy: 22/186 (11.8%)
Effect: Relative Effect (95% CI): RR 0.91 (0.56 to 1.48)
Absolute Effect (95% CI): 11 fewer per 1,000 (from 52 fewer to 57 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity receive MTX monotherapy or boDMARD monotherapy or tsDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity
Intervention: MTX monotherapy
Comparator: JAK Inhibitor
Outcome: Withdrawal due to adverse events (follow up: 2 years)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
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.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: JAKi (Tofa): 40/373 (10.7%)
MTX monotherapy: 25/186 (13.4%)
Effect: Relative Effect (95% CI): RR 0.80 (0.50 to 1.27)
Absolute Effect (95% CI): 27 fewer per 1,000 (from 67 fewer to 36 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity receive MTX monotherapy or boDMARD monotherapy or tsDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity
Intervention: MTX monotherapy
Comparator: JAK Inhibitor
Outcome: Death (follow up: 2 years)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: JAKi (Tofa): 3/373 (0.8%)
MTX monotherapy: 0/186 (0.0%)
Effect: Relative Effect (95% CI): RR 3.50 (0.18 to 67.41)
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 MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity receive MTX monotherapy or boDMARD monotherapy or tsDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity
Intervention: MTX monotherapy
Comparator: JAK Inhibitor
Outcome: Malignancy (follow up: 2 years)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by one level due to serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting no effect.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: JAKi (Tofa): 2/373 (0.5%)
MTX monotherapy: 1/186 (0.5%)
Effect: Relative Effect (95% CI): RR 1.00 (0.09 to 10.93)
Absolute Effect (95% CI): 0 fewer per 1,000 (from 5 fewer to 53 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity receive MTX monotherapy or boDMARD monotherapy or tsDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and moderate to high disease activity
Intervention: MTX monotherapy
Comparator: JAK Inhibitor
Outcome: Malignancy (from SRs on harms)

Evidence assessment:
GRADE: result_interpretation: The systematic review RefID=1220, 2017 (RCTs=3) comparing tofacitinib 5mg vs placebo + csDMARD among RA showed that for cancer, the result was Peto OR=2.39 (0.50, 11.50)
Study design: Systematic Review
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Disease activity (follow up: range 6 months to 12 months; assessed with: DAS28-ESR (Lower values – > benefit) (MCID -1.17)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: We did not downgrade due to risk of bias. The one study that contributed 76% of the weight is at low risk of bias; the other study suffers from lack of blinding of participants and personnel and lack of blinding of outcome assessment for non-radiographic outcomes.
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 the same dose of the boDMARD or tsDMARD: 250
Lower the dose of the boDMARD or tsDMARD: 248
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.06 lower (0.24 lower to 0.12 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Flare (follow up: range 6 months to 12 months)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of allocation concealment in one study and lack of blinding of participants and personnel in both studies.
Inconsistency: result: SERIOUS
rationales: Downgraded by one level due to serious inconsistency. Unexplained heterogeneity I2=65%
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.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Continue the same dose of the boDMARD or tsDMARD: 105
Lower the dose of the boDMARD or tsDMARD: 105(35.2%)
Effect: Relative Effect (95% CI): HR 0.68 (0.39 to 1.19)
Absolute Effect (95% CI): 97 fewer per 1,000 (from 196 fewer to 51 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Radiographic progression (follow up: range 6 months to 12 months; assessed with: Larsen/Sharp (Lower values – > benefit) (values > 0.2 are considered clinically important)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
rationales: I2=43%
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: CI includes both values suggesting harm and values suggesting no effect. According to the Cochrane's handbook, Cohen suggested that SMD=0.2 be considered a 'small' effect size, 0.5 represents a 'medium' effect size and 0.8 a 'large' effect size. This means that if two groups' means do not differ by 0.2 standard deviations or more, the difference is trivial, even if it is statistically significant.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Continue the same dose of the boDMARD or tsDMARD: 234
Lower the dose of the boDMARD or tsDMARD: 231
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): SMD 0.13 higher (0.06 lower to 0.31 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Fatigue (follow up: range 6 months to 12 months; assessed with: FACIT-F (Higher values – > benefit) (MCID 15.9)
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 the same dose of the boDMARD or tsDMARD: 250
Lower the dose of the boDMARD or tsDMARD: 248
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.79 lower (2.01 lower to 0.44 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Pain (follow up: range 6 months to 12 months; assessed with: VAS pain (0-100) (Lower values – > benefit) (MCID -11.9)
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 the same dose of the boDMARD or tsDMARD: 250
Lower the dose of the boDMARD or tsDMARD: 248
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 2.92 lower (6.34 lower to 0.5 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Disability (follow up: range 6 months to 12 months; assessed with: HAQ-DI (Lower values – > benefit) (MCID -0.22)
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 the same dose of the boDMARD or tsDMARD: 251
Lower the dose of the boDMARD or tsDMARD: 248
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.09 lower (0.19 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Quality of Life (follow up: range 6 months to 12 months; assessed with: EQ-5D (Higher values – > benefit) (MCID 0.1)
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 the same dose of the boDMARD or tsDMARD: 251
Lower the dose of the boDMARD or tsDMARD: 248
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0 (0.03 lower to 0.04 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
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: CI includes both values suggesting harm and values suggesting no effect. According to the Cochrane's handbook, Cohen suggested that SMD=0.2 be considered a 'small' effect size, 0.5 represents a 'medium' effect size and 0.8 a 'large' effect size. This means that if two groups' means do not differ by 0.2 standard deviations or more, the difference is trivial, even if it is statistically significant.
Very small number of events
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue the same dose of the boDMARD or tsDMARD: 7/202 (3.5%)
Lower the dose of the boDMARD or tsDMARD: 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Serious adverse events (follow up: range 6 months to 12 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
rationales: I2=47%
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Very 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 the same dose of the boDMARD or tsDMARD: 12/221 (5.4%)
Lower the dose of the boDMARD or tsDMARD: 10/230 (4.3%)
Effect: Relative Effect (95% CI): RR 1.28 (0.56 to 2.91)
Absolute Effect (95% CI): 12 more per 1,000 (from 19 fewer to 83 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Cardiovascular disease (follow up: 6 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded for risk of bias as the one included study did not blind participants, providers, or outcome assessors
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Very small number of events
CI includes both values suggesting benefit and values suggesting harm
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Continue the same dose of the boDMARD or tsDMARD: 3/19 (15.8%)
Lower the dose of the boDMARD or tsDMARD: 4/28 (14.3%)
Effect: Relative Effect (95% CI): RR 1.11 (0.28 to 4.39)
Absolute Effect (95% CI): 16 more per 1,000 (from 103 fewer to 484 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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
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: Very 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 the same dose of the boDMARD or tsDMARD: 2/202 (1.0%)
Lower the dose of the boDMARD or tsDMARD: 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
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: lower the dose of the boDMARD or tsDMARD
Outcome: Death (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: Very small number of events
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue the same dose of the boDMARD or tsDMARD: 2/202 (1.0%)
Lower the dose of the boDMARD or tsDMARD: 0/202 (0.0%)
Effect: Relative Effect (95% CI): RR 5.00 (0.24 to 103.50)
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 MTX + boDMARD or tsDMARD who are at target continue the boDMARD or tsDMARD at the same dose or lower the dose or increase the interval between doses of the boDMARD or tsDMARD (MTX continued at same dose)?
Population: Patients with RA on MTX + boDMARD or tsDMARD who are at target
Intervention: Continue the same dose of the boDMARD or tsDMARD
Comparator: increase the interval between the doses of the boDMARD or tsDMARD
Outcome: Disease activity (follow up: 3 months; 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 of participants and personnel.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Continue the same dose of the boDMARD or tsDMARD: 73
Increase the interval between the doses of the boDMARD or tsDMARD: 64
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.2 lower (0.56 lower to 0.16 higher)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio