somewordstoolate/Q2CRBench-3 huggingface dataset:
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on two or more DMARDs who are at target for less than six months withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for less than six months
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
Outcome: Pain (follow up: 1 year; 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: SERIOUS
rationales: CI interval includes both values suggesting harm and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Withdraw one DMARD: 398  
Continue current therapy: 201  
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 9.04 higher (5.62 higher to 12.46 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 two or more DMARDs who are at target for less than six months withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for less than six months
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
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: NOT_SERIOUS
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: CI interval includes both values suggesting harm and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Withdraw one DMARD:  398
Continue current therapy: 201  
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.2 higher (0.11 higher to 0.29 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 two or more DMARDs who are at target for less than six months withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for less than six months
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
Outcome: Quality of Life (follow up: 1 year; assessed with: EuroQol-5 (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: Withdraw one DMARD: 398 
Continue current therapy: 201 
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.05 lower (0.09 lower to 0.01 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 two or more DMARDs who are at target for less than six months withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for less than six months
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
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: SERIOUS
rationales: Very small number of events
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Withdraw one DMARD: 54/402 (13.4%) 
Continue current therapy: 4/202 (2.0%)  
Effect: Relative Effect (95% CI): RR 6.78(2.49 to 18.47
Absolute Effect (95% CI): 114 more per 1,000(from 30 more to 346 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 two or more DMARDs who are at target for less than six months withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for less than six months
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
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 interval includes both values suggesting benefit and values suggesting harm
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Withdraw one DMARD: 9/402 (2.2%) 
Continue current therapy: 7/202 (3.5%)  
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): RR 0.65 (0.24 to 1.71)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on two or more DMARDs who are at target for less than six months withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for less than six months
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
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: CI interval includes both values suggesting harm and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Withdraw one DMARD: 22/402 (5.5%)  
Continue current therapy: 12/202 (5.9%)  
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): RR 0.92 (0.47 to 1.82)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on two or more DMARDs who are at target for less than six months withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for less than six months
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
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: CI interval includes both values suggesting harm and values suggesting no effect
Very small number of events
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Withdraw one DMARD: 5/402 (1.2%) 
Continue current therapy: 2/202 (1.0%)  
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): RR 0.75 (0.17 to 3.33)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with RA on two or more DMARDs who are at target for six months and longer withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for six months and longer
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
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: Concern about the lack of blinding of participants and providers
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: Withdraw one DMARD: 64
Continue current therapy: 73
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.1 higher (0.02 higher to 0.18 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 two or more DMARDs who are at target for six months and longer withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for six months and longer
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
Outcome: Flare (follow up: range 11 months to 18 months)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: All included studies are at risk of bias
Inconsistency: result: SERIOUS
rationales: I2=55%
Indirectness: result: NOT_SERIOUS
Imprecision: result: NOT_SERIOUS
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Withdraw one DMARD: 645
Continue current therapy: 382(25.4%)
Effect: Relative Effect (95% CI): HR 2.61 (2.11 to 3.23)
Absolute Effect (95% CI): 281 more per 1,000 (from 207 more to 358 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 two or more DMARDs who are at target for six months and longer withdraw DMARDs or continue DMARDs?
Population: Patients with RA on two or more DMARDs at target for six months and longer
Intervention: Withdraw one DMARD (or more than one DMARD as long as the patient remains on at least one DMARD)
Comparator: Continue current therapy
Outcome: Disability (follow up: 3 months; assessed with: HAQ-DI (Lower values – > benefit) (MCID -0.22)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Concern about the lack of blinding of participants and providers
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: CI includes both values suggesting harms and values suggesting no effect
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Withdraw one DMARD: 64
Continue current therapy: 73
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.09 higher (0.11 lower to 0.29 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 DMARD monotherapy who are in low disease activity gradually taper off DMARD, abruptly withdraw DMARD, or continue DMARD at the same dose?
Population: Patients with RA on DMARD monotherapy who are in low disease activity
Intervention: Taper off DMARD
Comparator: Abruptly withdraw DMARD
Outcome: Relapse (follow up: 1 year; assessed with DAS28 CRP>2.7 )
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Study did not report on handling confounding; also high rate of missing data
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: SERIOUS
rationales: Very low number of participants and number of events
Other considerations: result: none
Study design: Observational Study
Certainty: VERY LOW
No of participants: Abruptly withdraw DMARD: 8/16 (50.0%)
continue DMARD at same dose: 2/20 (10.0%)
Effect: Relative Effect (95% CI): RR 5.00 (1.23 to 20.34)
Absolute Effect (95% CI): 400 more per 1,000 (from 23 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 MTX + boDMARD or MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
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: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
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: MODERATE
No of participants: Continue: 80
Withdraw (Taper/Stop) MTX: 79
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.07 lower (0.4 lower to 0.27 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 MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
Outcome: Disability (follow up: 3 months; assessed with: HAQ-DI (Lower values – > benefit) (MCID -0.22)
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
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: MODERATE
No of participants: Continue: 82
Withdraw (Taper/Stop) MTX: 82
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 0.04 higher (0.11 lower to 0.19 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 MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
Outcome: Quality of life (follow up: 3 months; assessed with: SF-36 PCS (Higher values – > benefit) (MCID 4.4)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
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 benefit. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Continue: 82
Withdraw (Taper/Stop) MTX: 82
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 3.38 higher (0.69 higher to 6.07 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 MTX + boDMARD or MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
Outcome: Quality of life (follow up: 3 months; assessed with:  SF-36 MCS (Higher values – > benefit) (MCID 3.1)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
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. Very small sample size.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Continue: 82
Withdraw (Taper/Stop) MTX: 82
Effect: Relative Effect (95% CI): -
Absolute Effect (95% CI): MD 1.88 lower (4.78 lower to 1.02 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 MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
Outcome: Serious adverse events (follow up: 3 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, and low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue: 1/83 (1.2%)
Withdraw (Taper/Stop) MTX: 4/82 (4.9%)
Effect: Relative Effect (95% CI): RR 0.25 (0.03 to 2.16)
Absolute Effect (95% CI): 37 fewer per 1,000 (from 47 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 RA on MTX + boDMARD or MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
Outcome: Withdrawal due to lack of efficacy (follow up: 3 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Confidence interval includes both values suggesting benefit and values suggesting harm. Very small sample size, and low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue: 0/83 (0.0%)
Withdraw (Taper/Stop) MTX: 1/82 (1.2%)
Effect: Relative Effect (95% CI): RR 0.33 (0.01 to 7.97)
Absolute Effect (95% CI): 8 fewer per 1,000 (from 12 fewer to 85 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 MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
Outcome: Withdrawal due to adverse events (follow up: 3 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
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 benefit. Very small sample size, and low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: MODERATE
No of participants: Continue: 3/83 (3.6%)
Withdraw (Taper/Stop) MTX: 1/82 (1.2%)
Effect: Relative Effect (95% CI): RR 2.96 (0.31 to 27.91)
Absolute Effect (95% CI): 24 more per 1,000 (from 8 fewer to 328 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 MTX + tsDMARD who are at target withdraw (taper off or abruptly stop) MTX or withdraw (taper off or abruptly stop) the boDMARD or the tsDMARD?
Population: Patients with RA on MTX + boDMARD or MTX + tsDMARD who are at target
Intervention: Withdraw (taper off or abruptly stop) MTX
Comparator: Continue same management
Outcome: Death (follow up: 3 months)
Importance: IMPORTANT

Evidence assessment:
GRADE: Risk of bias: result: NOT_SERIOUS
rationales: Concern with risk of bias. Missing data was not appropriately handled in the trial.
Inconsistency: result: NOT_SERIOUS
Indirectness: result: NOT_SERIOUS
Imprecision: result: VERY_SERIOUS
rationales: Downgraded by two levels due to very serious imprecision. Very small sample size, and very low number of events.
Other considerations: result: none
Study design: Randomized Controlled Trial
Certainty: LOW
No of participants: Continue: 0/83 (0.0%)
Withdraw (Taper/Stop) MTX: 0/82 (0.0%)
Effect: Relative Effect (95% CI): not estimable
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio
Guideline: 2021 ACR RA
Clinical question: Should patients with MTX-naïve and non-MTX csDMARDs naïve 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 naïve RA and moderate to high disease activity
Intervention: MTX monotherapy
Comparator: TNF Inhibitor
Outcome: Disease activity (follow up: 2 years; assessed with: ACR 20 )
Importance: CRITICAL

Evidence assessment:
GRADE: Risk of bias: result: SERIOUS
rationales: Downgraded by one level due to serious risk of bias. Lack of allocation concealment.
Inconsistency: result: SERIOUS
rationales: Downgraded by one level due to serious inconsistency. Unexplained heterogeneity I2=65%. 
Indirectness: result: SERIOUS
rationales: Downgraded by one level due to serious indirectness. The evidence is based on a non-MTX csDMARD exposed population.
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: TNF inhibitor: 207/467 (44.3%)
MTX monotherapy: 205/459 (44.7%)
Effect: Relative Effect (95% CI): RR 0.99 (0.86 to 1.15)
Absolute Effect (95% CI): 4 fewer per 1,000 (from 63 fewer to 67 more)
Abbreviations: CI: Confidence interval; RR: Risk ratio; MD: Mean difference; HR: Hazard Ratio