Which RA drug works best after the first one fails? a major trial aims to find out
NCT ID NCT04692493
First seen Jul 17, 2026 · Last updated Jul 17, 2026
Summary
This study compares two treatment strategies for people with active rheumatoid arthritis (RA) who have already tried a type of biologic called a TNF inhibitor. Participants are randomly assigned to switch to either a different class of biologic (non-TNFi) or a newer oral medication called a targeted synthetic DMARD. The goal is to see which approach better improves daily function and symptoms, providing real-world evidence to guide treatment decisions.
What this could mean
Our plain-language read of the trial. This is informational only — not medical advice or a prediction.
- Active substance
- switching to either a non-TNFi biologic (rituximab, abatacept, tocilizumab, or sarilumab) or a targeted synthetic DMARD (tofacitinib, baricitinib, or upadacitinib)
- What this could lead to
- If successful, this trial could provide clear evidence on which treatment strategy works better for people with rheumatoid arthritis who have not responded to a TNFi biologic, helping doctors and patients make more informed choices.
- What could go wrong
- This is a real-world study, not a tightly controlled lab experiment, so results may be influenced by factors like patient preferences or insurance coverage. Also, the treatments compared are already approved, so the study may not lead to a new drug.
This is an AI summary of the original study and may miss details. Read our disclaimer.
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Conditions
The condition(s) this trial relates to.
As listed by the trial registrant
The condition terms exactly as the trial's registrant entered them.
Contacts and locations
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Study contacts
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Allegheny Health Network
RECRUITINGPittsburgh, Pennsylvania, 15212, United States
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Altoona Center for Clinical Research
RECRUITINGDuncansville, Pennsylvania, 16635, United States
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American Arthritis and Rheumatology Associates -Mi PLLC
RECRUITINGOkemos, Michigan, 48864, United States
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American Arthritis and Rheumatology Associates LLC
RECRUITINGClearwater, Florida, 33765, United States
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American Arthritis and Rheumatology Associates LLC
RECRUITINGFort Lauderdale, Florida, 33309, United States
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American Arthritis and Rheumatology Associates-Tx PLLC
RECRUITINGHarlingen, Texas, 78550, United States
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Arthritis & Rheumatology Center of South Florida
RECRUITINGMargate, Florida, 33063, United States
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Arthritis Medical Center
RECRUITINGNipomo, California, 93444, United States
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Arthritis and Rheumatology of Southwest Ohio
RECRUITINGLiberty Township, Ohio, 45069, United States
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Baylor University
RECRUITINGHouston, Texas, 77030, United States
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Bendcare, LLC
RECRUITINGBirmingham, Alabama, 35244, United States
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CZ Rheumatology
RECRUITINGCoral Springs, Florida, 33065, United States
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Center for Rheumatology Research
RECRUITINGWoodland Hills, California, 91364, United States
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Cumberland Rhematology
RECRUITINGCrossville, Tennessee, 38555, United States
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Dr. Jayashree Sinha
RECRUITINGClovis, New Mexico, 88101, United States
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East Alabama Arthritis Center PC
RECRUITINGAuburn, Alabama, 36830, United States
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George Munoz MD, PC
RECRUITINGAventura, Florida, 33180, United States
Contact Phone: •••-•••-•••• Email: •••••@•••••
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Heritage Rheumatology and Arthritis Care
RECRUITINGColleyville, Texas, 76034, United States
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Hospital for Special Surgery
RECRUITINGNew York, New York, 10021, United States
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Indiana University Health
RECRUITINGCarmel, Indiana, 46280, United States
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Inspire Santa Fe Medical Group
RECRUITINGSanta Fe, New Mexico, 87505, United States
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Johns Hopkins University
RECRUITINGBaltimore, Maryland, 21224, United States
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Life Medical Research Group
RECRUITINGMiami Gardens, Florida, 33014, United States
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Mayo Clinic Jacksonville
RECRUITINGJacksonville, Florida, 32224, United States
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Mayo Clinic Rochester
RECRUITINGRochester, Minnesota, 55905, United States
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Mount Sinai Hospital (Canada)
RECRUITINGToronto, Ontario, M5T 3L9, Canada
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New York University
RECRUITINGNew York, New York, 10016, United States
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Northern Virginia Center for Arthritis-Reston
RECRUITINGReston, Virginia, 20190, United States
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Oregon Health and Science University
RECRUITINGPortland, Oregon, 97239, United States
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PA Regional Center for Arthritis and Osteoporosis Research
RECRUITINGWyomissing, Pennsylvania, 19610, United States
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Pacific Arthritis Care Center
RECRUITINGLos Angeles, California, 90045, United States
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Palm Beach Rheumatology and Wellness
RECRUITINGJupiter, Florida, 33458, United States
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Rheumatology and Arthritis Care Center
RECRUITINGExton, Pennsylvania, 19341-2547, United States
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Saint Paul Rheumatology, P.A.
RECRUITINGEagan, Minnesota, 55121, United States
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Southeast Georgia Physician Associates-Rheumatology
RECRUITINGBrunswick, Georgia, 31520, United States
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Southern Ohio Rheumatology
RECRUITINGWheelersburg, Ohio, 45694, United States
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Southwest Florida Rheumatology
RECRUITINGRiverview, Florida, 33569, United States
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Southwest Medical Center
RECRUITINGDallas, Texas, 75235, United States
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SunValley Arthritis Center, Ltd
RECRUITINGPeoria, Arizona, 85381, United States
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Texas Arthritis Center, PA
RECRUITINGEl Paso, Texas, 77902, United States
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The MetroHealth System
RECRUITINGCleveland, Ohio, 44109, United States
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Tufts University
RECRUITINGBoston, Massachusetts, 02111, United States
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Turlock Arthritis & Osteoporosis Center,
RECRUITINGTurlock, California, 95382, United States
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University Hospital Cleveland Medical Ctr
RECRUITINGCleveland, Ohio, 44106, United States
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University of Alabama at Birmingham
RECRUITINGBirmingham, Alabama, 35294, United States
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University of Arizona
RECRUITINGTucson, Arizona, 85724, United States
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University of California, Los Angeles
RECRUITINGLos Angeles, California, 90095, United States
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University of Massachusetts Chan Medical School
RECRUITINGWorcester, Massachusetts, 01655, United States
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Vanderbilt University
RECRUITINGNashville, Tennessee, 37235, United States
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More trials for these conditions
Other studies related to the condition(s) this trial covers.
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- Rheumatoid arthritis drug safety showdown: baricitinib vs. TNF inhibitors