Biologic or tofacitinib monotherapy for rheumatoid arthritis in people with traditional disease‐modifying anti‐rheumatic drug (DMARD) failure: a Cochrane Systematic Review and network meta‐analysis (NMA)
Biologics or tofacitinib for people with rheumatoid arthritis unsuccessfully treated with biologics: a systematic review and network meta‐analysis
What can we do when an RA patient fails to respond adequately to a conventional synthetic DMARD (csDMARD) like Methotrexate, or to even a first-line biologic DMARD (bDMARD), typically an anti-TNF?
1) Do we switch to another anti-TNF, or to a different targeted therapy like Tocilizumab, Abatacept or a targeted synthetic DMARD (tsDMARD) like Tofacitinib?
2) Do we combine with other csDMARDs, or switch to another bDMARD/tsDMARD as monotherapy, or should we add on the bDMARD/tsDMARD to the existing csDMARD?
In these days of escalating health costs, especially the stratospheric pricing of bDMARDs/tsDMARDs, and with the emerging biosimilars coming onto the market priced competitively a third cheaper, should we not switch to such if bioequivalence in clinically efficacy and safety have been demonstrated? I think so.