Position statements

Guidelines for the use of TNF a Blocker Switching

SARAA wishes to follow European guidelines and places no restriction on which TNF-a blocker may be switched or how many switches are allowed.

Switches should however be based on clinical grounds, as in lack of efficacy: less than 10-20 SDAI improvement score after 3 months or failure to achieve low disease activity: SDAI score < 20 during the later course of treatment.

Switching may also occur due to adverse events or patient preference, but drug hopping is discouraged.

SDAI scoring attached.

Reference: Ann Rheum Dis 2005;64: iv2-iv14.


Rheumatoid arthritis patients who have failed at least one TNF-a blocker, non-responders with SDAI improvement score < 10 or partial responders with SDAI improvement score less than 10-20, are eligible for the use of MabThera.

Please note: SDAI scoring includes CRP in mg/dL, this means the local CRP score must be divided by 10.