somewordstoolate/Q2CRBench-3 huggingface dataset:
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 Rituximab
Outcome: Disease activity (follow up: 6 months; assessed with DAS 28-ESR (Lower values – > benefit) (MCID -1.17)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: 'Other limitations of this observational study are the relative low numbers of patients and the high number of missing data.'
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. Small sample size.
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Switching to a 3rd TNF Inhibitor: 43
switching to rituximab: 58
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.35 lower (1.82 lower to 1.12 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 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 Rituximab
Outcome: Low disease activity (follow up: 6 months; assessed with DAS28 ≤ 3.2)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: 'Other limitations of this observational study are the relative low numbers of patients and the high number of missing data.'
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. Small sample size.
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Switching to a 3rd TNF Inhibitor: 6/35 (17.1%)
switching to rituximab: 20/69 (29.0%)
Effect: Relative Effect (95% CI): RR 0.59 (0.26 to 1.34)
Absolute Effect (95% CI): 119 fewer per 1,000 (from 214 fewer to 99 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 Rituximab
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: 'Other limitations of this observational study are the relative low numbers of patients and the high number of missing data.'
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. Small sample size.
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Switching to a 3rd TNF Inhibitor: 35
switching to rituximab: 54
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0 (0.53 lower to 0.53 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 Rituximab
Outcome: Withdrawal due to lack of efficacy (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: 'Other limitations of this observational study are the relative low numbers of patients and the high number of missing data.'
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to very serious imprecision. Confidence interval includes both values suggesting no effect and values suggesting harm. Small sample size.
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Switching to a 3rd TNF Inhibitor: 15/64 (23.4%)
switching to rituximab: 10/90 (11.1%)
Effect: Relative Effect (95% CI): RR 2.11 (1.01 to 4.39)
Absolute Effect (95% CI): 123 more per 1,000 (from 1 more to 377 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 Rituximab
Outcome: Withdrawal due to adverse events (follow up: 1 year)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: 'Other limitations of this observational study are the relative low numbers of patients and the high number of missing data.'
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to very serious imprecision. Confidence interval includes both values suggesting no effect and values suggesting harm. Small sample size.
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Switching to a 3rd TNF Inhibitor: 14/64 (21.9%)
switching to rituximab: 1/90 (1.1%)
Effect: Relative Effect (95% CI): RR 19.69 (2.66 to 145.95)
Absolute Effect (95% CI): 208 more per 1,000 (from 18 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 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: 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: 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, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 3rd TNFi: 8/13 (61.5%)
Continue same management: 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 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: 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: 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, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 3rd TNFi: 4/13 (30.8%)
Continue same management: 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 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: Continue same management
Outcome: Disease activity (follow up: 4 months; assessed with: DAS28-ESR (Lower values – > benefit) (MCID -1.17)
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: 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 no effect. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 3rd TNFi: 13
Continue same management: 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 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: 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: 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, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 3rd TNFi: 8/13 (61.5%)
Continue same management: 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 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: Continue same management
Outcome: Radiographic progression (follow up: 4 months; assessed with: Sharp/ van der Heijde (Lower values – > benefit) (MCID 4.6)
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: 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.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 3rd TNFi: 12
Continue same management: 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 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: 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: 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, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 3rd TNFi: 0/13 (0.0%)
Continue same management: 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 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: 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: 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, very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Switch to a 3rd TNFi: 2/13 (15.4%)
Continue same management: 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: 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
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on DMARDs who are NOT at target receive IA corticosteroids alone or add/switch DMARDs or IA corticosteroids and add/switch DMARD(s)?
Population: Patients with RA on DMARDs who are not at target
Intervention: IA steroids
Comparator: add/Switch DMARD(s)
Outcome: Disease activity (follow up: 3 months; assessed with: ACR 20)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious risk of bias. Lack of allocation concealment, lack of blinding, and selective reporting.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. Study compared IA GCs + csDMARD to csDMARDs.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting no effect and value suggesting harm. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: IA corticosteroids alone: 25/25 (100.0%)
Add/Switch DMARD(s): 21/25 (84.0%)
Effect: Relative Effect (95% CI): RR 1.19 (0.99 to 1.43)
Absolute Effect (95% CI): 160 more per 1,000 (from 8 fewer to 361 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 DMARDs who are NOT at target receive IA corticosteroids alone or add/switch DMARDs or IA corticosteroids and add/switch DMARD(s)?
Population: Patients with RA on DMARDs who are not at target
Intervention: IA steroids
Comparator: add/Switch DMARD(s)
Outcome: Disease activity (follow up: 3 months; assessed with: ACR 50)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by two levels due to very serious risk of bias. Lack of allocation concealment, lack of blinding, and selective reporting.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. Study compared IA GCs + csDMARD to csDMARDs.
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: IA corticosteroids alone: 15/25 (60.0%)
Add/Switch DMARD(s): 5/25 (20.0%)
Effect: Relative Effect (95% CI): RR 3.00 (1.29 to 7.00)
Absolute Effect (95% CI): 400 more per 1,000 (from 58 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 DMARDs who are NOT at target receive IA corticosteroids alone or add/switch DMARDs or IA corticosteroids and add/switch DMARD(s)?
Population: Patients with RA on DMARDs who are not at target
Intervention: IA steroids
Comparator: add/Switch DMARD(s)
Outcome: Disease activity (follow up: 3 months; assessed with: ACR 70)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious risk of bias. Lack of allocation concealment, lack of blinding, and selective reporting.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. Study compared IA GCs + csDMARD to csDMARDs.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very small sample size and low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: IA corticosteroids alone: 9/25 (36.0%)
Add/Switch DMARD(s): 0/25 (0.0%)
Effect: Relative Effect (95% CI): RR 19.00 (1.17 to 309.77)
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 DMARDs who are NOT at target receive IA corticosteroids alone or add/switch DMARDs or IA corticosteroids and add/switch DMARD(s)?
Population: Patients with RA on DMARDs who are not at target
Intervention: IA steroids
Comparator: add/Switch DMARD(s)
Outcome: Disease activity (follow up: 3 months; assessed with: DAS28-ESR)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious risk of bias. Lack of allocation concealment, lack of blinding, and selective reporting.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. Study compared IA GCs + csDMARD to csDMARDs.
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: IA corticosteroids alone: 25
Add/Switch DMARD(s): 25
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 1.6 lower (2.21 lower to 0.99 lower)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio