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Rheumatoid Arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 43-year-old woman with RA on Methotrexate and Adalimumab has a DAS28-CRP of 5.3. She has failed Adalimumab (secondary loss of response after 18 months). What treatment strategy is recommended according to NICE?

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Correct answer: E — Switch to an alternative TNF inhibitor or a different mechanism of action biologic

After failure of a first TNF inhibitor, NICE TA375 recommends switching to an alternative biologic. This can be another TNF inhibitor (especially for secondary loss of response suggesting anti-drug antibodies) or a different mechanism of action (Rituximab, Tocilizumab, Abatacept, Sarilumab, or a JAK inhibitor). Secondary failure is commonly due to immunogenicity and switching within the TNF class can be effective. Primary failure more often warrants switching mechanism.

Reference: NICE TA375 (2016); BSR 2019 biologic safety guidelines; EULAR 2022 RA recommendations