Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia.
Department of Rheumatology, Gaetano Pini Institute, Milan.
Rheumatology (Oxford). 2018 Oct 1;57(57 Suppl 7):vii42-vii53. doi: 10.1093/rheumatology/key195.
To establish evidence-based and experts' opinion filtered statements on the optimal treatment choice between cycling (switch) and changing mode of action strategies (swap) in RA patients failing TNF inhibitors (TNFis).
The relevant question (switch vs swap) was rephrased into a research question according to the population, intervention, comparison and outcome (PICO) strategy, considering all the available scientific evidence published from the 2013 EULAR set of recommendations up to mid-January 2016. Final statements derived from the retrieved scientific evidence and experts' consensus, with eventual rephrasing through a Delphi method during a national consensus of Italian rheumatologists.
From a total of 365 records, 12 studies were finally included. The final statements argued that, until head-to-head comparison data are available, switch and swap can be still considered suitable strategies in RA patients failing first TNFi, even though some data seem to lend more support to a different mode of action-targeted strategy.
After failure of first TNFi course, switch and swap can be currently considered as alternative suitable approaches in RA patients.
针对 TNF 抑制剂（TNFis）治疗失败的 RA 患者，建立基于循证医学和专家意见过滤的关于选择循环（转换）和改变作用模式策略（交换）的最佳治疗方案的证据。
根据人群、干预、比较和结局（PICO）策略，将相关问题（转换与交换）重新表述为一个研究问题，同时考虑从 2013 年 EULAR 推荐集发表的所有现有科学证据，直至 2016 年 1 月中旬。最终陈述来自检索到的科学证据和专家共识，最终通过意大利风湿病学家的全国共识会议，通过德尔菲法进行重新表述。
从总共 365 份记录中，最终纳入了 12 项研究。最终陈述认为，在头对头比较数据可用之前，转换和交换仍可被视为首次 TNFis 治疗失败的 RA 患者的合适策略，尽管一些数据似乎更倾向于不同作用模式靶向策略。
在首次 TNFis 治疗失败后，转换和交换可被视为 RA 患者的另一种合适的治疗方法。
