9
c
Treatment target should ideally be low disease activity or remission.
d
Tapering denotes scaling back therapy (reducing dose or dosing frequency), not discontinuing it
and, if done, must be conducted slowly and carefully.
Non-TNF biologic
+/- MTX or
TNFi +/- MTX
Treat to
Target
c
Another Non-TNF
biologic +/- MTX
Moderate or
High Disease
Activity
a, b
Another Non-
TNF biologic
+/- MTX or
Tofacitinib +/-
MTX
Non-TNF biologic
+/- MTX or
Tofacitinib +/-
MTX
TNFi +/- MTX
(in TNFi naïve) or
Tofacitinib +/-
MTX
Do not
discontinue
all RA
treatments
d
Moderate or
High Disease
Activity
a, b
Multiple TNFi
failure
Dual
Failure:
TNFi and Non-
TNF biologic
failure
Multiple Non-
TNF biologic
failure
Single Non-
TNF biologic
failure
Single TNFi
failure
Moderate or
High Disease
Activity
a, b
