Abstract

Tumour necrosis factor inhibitors (anti-TNF) improve considerably the signs and symptoms of severe rheumatoid arthritis (RA) in the majority of patients. Nonetheless, about a third of patients do not respond satisfactorily to this class of biological agents and many more loose response over time or can not tolerate them. In this clinical setting, randomized trials have demonstrated that a second anti-TNF or a biological agent of a different class (abatacept, rituximab, tocilizumab) may be effective. This review summarizes current evidence for existing therapeutic options in patients with an inadequate response to a first anti-TNF. The choice of an optimal treatment strategy needs to be tailored to the individual patient and take into account the reasons for prior anti-TNF interruption.

Keywords: Antirheumatic therapy, anti-TNF or Tumour Necrosis Factor inhibitors, therapeutic inadequate response, switching biologic agents, rheumatoid arthritis (RA, abatacept, rituximab, tocilizumab, Disease-modifying antirheumatic drugs (DMARDs), certolizumab, etanercept, infliximab, Methotrexate, CD20+ B cells, ATTAIN, REFLEX, RADIATE