somewordstoolate/Q2CRBench-3 huggingface dataset:
Guideline: 2021 ACR RA
Clinical question: Should patients with MTX-naïve and non-MTX csDMARDs naïve RA and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs naïve RA and low disease activity
Intervention: MTX monotherapy
Comparator: SSZ
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 allocation and lack of blinding of outcome assessors of non-radiographic outcomes in the study with the higher weight,
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity. 
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Small sample size. 
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: MTX monotherapy: 104
SSZ: 102
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.04 lower (0.2 lower to 0.13 higher)
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 naïve RA and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs naïve RA and low disease activity
Intervention: MTX monotherapy
Comparator: SSZ
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: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity. 
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. 
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: MTX monotherapy: 35
SSZ: 34
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.1 higher (13.46 lower to 13.66 higher)
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 naïve RA and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs naïve RA and low disease activity
Intervention: MTX monotherapy
Comparator: SSZ
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: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity. 
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. 
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: MTX monotherapy: 0/35 (0.0%)
SSZ: 3/34 (8.8%)
Effect: Relative Effect (95% CI): RR 0.14 (0.01 to 2.59)
Absolute Effect (95% CI): 76 fewer per 1,000 (from 87 fewer to 140 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 naïve RA and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs naïve RA and low disease activity
Intervention: MTX monotherapy
Comparator: SSZ
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 allocation and lack of blinding of outcome assessors of non-radiographic outcomes in the study with the higher weight,
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity. 
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 and low number of events. 
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: MTX monotherapy: 5/104 (4.8%)
SSZ: 10/102 (9.8%)
Effect: Relative Effect (95% CI): RR 0.51 (0.19 to 1.39)
Absolute Effect (95% CI): 48 fewer per 1,000 (from 79 fewer to 38 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 naïve RA and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs naïve RA and low disease activity
Intervention: MTX monotherapy
Comparator: SSZ
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 allocation and lack of blinding of outcome assessors of non-radiographic outcomes in the study with the higher weight,
Inconsistency: result: NOT_SERIOUS
rationales: I2= 44%
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity. 
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: Randomized Controlled Trial
Certainty: LOW
No of participants: MTX monotherapy: 9/104 (8.7%)
SSZ: 19/102 (18.6%)
Effect: Relative Effect (95% CI): RR 0.46 (0.22 to 0.98)
Absolute Effect (95% CI): 101 fewer per 1,000 (from 145 fewer to 4 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 naïve RA and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs naïve RA and low disease activity
Intervention: MTX monotherapy
Comparator: LEF
Outcome: Disease activity (follow up: 6 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 one level due to serious risk of bias. Lack of allocation concealment and lack of blinding of patients, personnel, and outcome assessors.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity.
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: MTX monotherapy: 147
LEF: 147
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.1 lower (0.27 lower to 0.07 higher)
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 and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and low disease activity
Intervention: MTX monotherapy
Comparator: LEF
Outcome: Disease activity (follow up: 4 months; assessed with: ACR 20)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity.
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: MTX monotherapy: 88/180 (48.9%)
LEF: 95/182 (52.2%)
Effect: Relative Effect (95% CI): RR 0.94 (0.76 to 1.15)
Absolute Effect (95% CI): 31 fewer per 1,000 (from 125 fewer to 78 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 and low disease activity receive MTX monotherapy or an alternative csDMARD monotherapy?
Population: Patients with MTX-naïve and non-MTX csDMARDs exposed RA and low disease activity
Intervention: MTX monotherapy
Comparator: LEF
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: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of blinding of patients, personnel, and outcome assessors.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population with moderate to high disease activity.
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. Small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: MTX monotherapy: 21
LEF: 19
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.67 lower (1.5 lower to 0.16 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Disease activity (follow up: 6 months; assessed with: ACR20)
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.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on maximally tolerated dose of MTX monotherapy and not LEF.
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence intervals include both values suggesting benefit and values suggesting harm. Concern about risk of bias associated with lack of allocation concealment taken into account when rating down for imprecision.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Add SSZ+HCQ: 89/159 (56.0%)
Add TNFi: 90/163 (55.2%)
Effect: Relative Effect (95% CI): RR 1.01 (0.83 to 1.23)
Absolute Effect (95% CI): 6 more per 1,000 (from 94 fewer to 127 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Disease activity (follow up: 6 months; assessed with: ACR50)
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.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on maximally tolerated dose of MTX monotherapy and not LEF.
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Confidence interval includes both values suggesting harm and values suggesting no effect.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Add SSZ+HCQ: 41/159 (25.8%)
Add TNFi: 58/163 (35.6%)
Effect: Relative Effect (95% CI): RR 0.72 (0.52 to 1.01)
Absolute Effect (95% CI): 100 fewer per 1,000 (from 171 fewer to 4 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Disease activity (follow up: 6 months; assessed with: ACR70)
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.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on maximally tolerated dose of MTX monotherapy and not LEF.
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Add SSZ+HCQ: 8/159 (5.0%)
Add TNFi: 26/163 (16.0%)
Effect: Relative Effect (95% CI): RR 0.32 (0.15 to 0.68)
Absolute Effect (95% CI): 108 fewer per 1,000 (from 136 fewer to 51 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Disease activity (follow up: 6 months; assessed with: DAS28-ESR)
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.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a population on maximally tolerated dose of MTX monotherapy and not LEF.
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Add SSZ+HCQ: 157
Add TNFi: 161
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.27 higher (0.01 lower to 0.55 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Remission (follow up: 6 months; assessed with: DAS28-CRP < 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 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 maximally tolerated dose of MTX monotherapy and not LEF.
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Confidence interval includes both values suggesting harm and values suggesting no effect.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Add SSZ+HCQ: 20/157 (12.7%)
Add TNFi: 35/161 (21.7%)
Effect: Relative Effect (95% CI): RR 0.59 (0.35 to 0.97)
Absolute Effect (95% CI): 89 fewer per 1,000 (from 141 fewer to 7 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Radiographic progression (follow up: 6 months; assessed with: mTSS)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. 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 maximally tolerated dose of MTX monotherapy and not LEF.
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Add SSZ+HCQ: 158
Add TNFi: 160
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.42 higher (0.22 lower to 1.05 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Disability (follow up: 6 months; assessed with: HAQ-DI)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. 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 maximally tolerated dose of MTX monotherapy and not LEF.
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Confidence interval includes both values suggesting harm and values suggesting no effect.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: VERY LOW
No of participants: Add SSZ+HCQ: 155
Add TNFi: 160
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.07 higher (0.11 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 maximally tolerated dose of LEF monotherapy who are NOT at target, and have previously failed MTX (due to an inadequate response or adverse events), add SSZ and HCQ, or add a boDMARD, or add tsDMARD?
Population: Patients with RA on maximally tolerated dose of LEF monotherapy who are not at target, and have previously failed MTX (due to an inadequate response or adverse events)
Intervention: Add SSZ and HCQ
Comparator: add TNF Inhibitor
Outcome: Malignancy (from SRs of harms)

Evidence assessment:
GRADE: result_interpretation: The Systematic Review RefID=4638, 2012 (RCTs=9, n=3712) comparing csDMARD + placebo vs infliximab + MTX among RA showed that for cancer, the result was RR=0.83 (0.22-3.13) at 2 years and RR=0.56(0.22-1.47) at all time points (6 months, 1 year and 2 years combined)
Study design: Systematic Review
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on DMARD(s) who are NOT at target switch to another DMARD versus add a 2nd DMARD?
Population: Patients with RA on non-biologic DMARD(s) who are not at target
Intervention: Switch to another DMARD
Comparator: Add another DMARD
Outcome: Disease activity (follow up: range 4 months to 2 years; assessed with: ACR 20)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Three studies at low risk of bias represent 60% of the weight.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: Downgraded by one level due to serious imprecision. Confidence interval includes both values suggesting no effect and values suggesting harm.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Switch DMARDs: 795/1279 (62.2%)
Add DMARDs: 1112/1658 (67.1%)
Effect: Relative Effect (95% CI): RR 0.93 (0.86 to 1.02)
Absolute Effect (95% CI): 47 fewer per 1,000 (from 94 fewer to 13 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 DMARD(s) who are NOT at target switch to another DMARD versus add a 2nd DMARD?
Population: Patients with RA on non-biologic DMARD(s) who are not at target
Intervention: Switch to another DMARD
Comparator: Add another DMARD
Outcome: Disease activity (follow up: range 4 months to 2 years; assessed with: ACR 50)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Three studies at low risk of bias represent 60% of the weight.
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: Switch DMARDs: 491/1279 (38.4%)
Add DMARDs: 744/1658 (44.9%)
Effect: Relative Effect (95% CI): RR 0.87 (0.79 to 0.97)
Absolute Effect (95% CI): 58 fewer per 1,000 (from 94 fewer to 13 fewer)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio