6 Recommendations for further research
6.1 Further clinical trials should be undertaken to compare the clinical effectiveness of adalimumab, etanercept and infliximab used sequentially after the failure of a TNF inhibitor with the clinical effectiveness of management strategies that do not include TNF inhibitors, including strategies that use untried DMARDs or biological DMARDs such as rituximab. This is important because there is currently no evidence on the clinical effectiveness of the TNF inhibitors at this stage in the treatment pathway compared with alternative treatment options (see section 4.3.6).
6.2 Further research should be undertaken to estimate utilities using directly observed health-related quality of life values (such as EQ−5D scores) in people with rheumatoid arthritis. This is important because current methods of establishing utility values do not allow for links to be made between utilities and common clinical measures such as DAS.