What should head-to-head studies in inflammatory arthritis teach us? Save

The multimillion dollar question for inflammatory arthritis prescriptions is: which drug should I use next?

For example, after MTX-IR, we have studies that suggest in RA:
JAKi>TNFi or equal
Upadacitinib>Adalimumab (Ada)
Barictinib 4mg >Adalimumab
Tofacitinib 5mg bid = Ada

And in monotherapy post MTX-IR,
IL6i>Ada
Tociluzimab > Ada
Sarilumab > Ada

#ACR25 had some important H2H studies:

PsA
IL17A>IL12/23i
Secukinumab > Ustekinumab for ACR50 and PASI at wk 28
#LB06

axSpA
TNFi vs IL17Ai post TNFi
RCT post TNFi to another TNFi or IL17Ai = ASAS40* and other secondary outcomes
(some favored switch but none were significant)
*except primary non responders did better switching out of class
#LB09

RA post TNFi-IR
Upa > Abatacept
bDMARD > TNFi

Upa > another TNFi
Upadacitinib higher remission (67.7%) vs another TNFi (40.3%)

So, we can learn the odds of improvement or remission on a group level. Maybe future guidelines will take in to consideration these H2H RCTs.