Real-world effectiveness of b/tsDMARD switching in low-inflammatory difficult-to-treat rheumatoid arthritis: insights from the FIRST registry
Authors' conclusion
A subset of patients with low-inflammatory D2T RA may benefit from b/tsDMARD switching, indicating that low-inflammatory status alone should not preclude consideration of treatment intensification.
Study context
- Population
- Low-inflammatory difficult-to-treat RA (swollen 28-joint count ≤1 and CRP <10 mg/L), multicentre FIRST registry, August 2013–March 2024low-inflammatory D2T RA
- Participants
- 173 participants
- Exposure
- b/tsDMARD switching vs no switching in low-inflammatory D2T RA
- Switchn = 15
- Non-switchn = 30reference
- Outcome
- Change in CDAI
- Follow-up
- 6 months
Methodological detailsmulticentre registry, propensity score-matched
- Multicentre registry
- Propensity score-matched
Main finding
As reported in the abstract
Change in CDAI (propensity score-matched)
Switch
−6.6
Non-switch
−2.2
P < 0.05
Observational data: associations, not effects.
Further findings
| Outcome | Switch | Non-switch | P value |
|---|---|---|---|
| Change in pain (propensity score-matched) · 6 monthsGreater improvement with switch | −15.3 | −3.4 | P < 0.05 |
Clinical Disease Activity Index (CDAI) with switching in low-grade sonographic activity (greyscale ≤1, power Doppler=0)
- CDAI before to after b/tsDMARD switching
- 16.8 to 9.7
Proportion receiving b/tsDMARD switching, low-inflammatory vs inflammatory D2T RA
- Low-inflammatory D2T RA
- 29/173 (16.8%)
- Inflammatory D2T RA
- 217/284 (76.4%)
Original publication
Real-world effectiveness of b/tsDMARD switching in low-inflammatory difficult-to-treat rheumatoid arthritis: insights from the FIRST registry. RMD Open. Published 5 February 2026. doi:10.
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