The 2015 ACR RA treatment guideline, based on widely acknowledged low to moderate quality
evidence, recommends adding TNFi-biologic, non-TNFi biologic or a tsDMARD to MTX in MTX-IR
patients with active RA.24 In practice, most patients receive a TNFi-biologic first. This is
not based on solid evidence, but on arbitrary algorithms often proposed by health insurance
plans, physician experience (first TNFi launched 22 yrs ago vs. first tsDMARD 8 yrs ago).
This study will fill a critical knowledge gap by generating CER data for important PROs
between these treatment options, adding TNFi-biologic or a tsDMARD to MTX in MTX-IR patients.