Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Are TNF inhibitors still the agent of choice for RA?

Since entering the clinic 25 years ago, biologic TNF inhibitors have transformed the outlook for people with rheumatoid arthritis and set the standard for all other targeted therapies. Despite changes to the therapeutic landscape, TNF inhibitors look set to remain an important treatment option for the foreseeable future.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Feldmann, M. & Maini, R. N. Lasker Clinical Medical Research Award. TNF defined as a therapeutic target for rheumatoid arthritis and other autoimmune diseases. Nat. Med. 9, 1245–1250 (2003).

    Article  CAS  PubMed  Google Scholar 

  2. Breedveld, F. C. et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 54, 26–37 (2006).

    Article  CAS  PubMed  Google Scholar 

  3. Klareskog, L. et al. TEMPO (Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes) study investigators. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 363, 675–681 (2004).

    Article  CAS  PubMed  Google Scholar 

  4. Gabay, C. et al. Tocilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA): a randomised, double-blind, controlled phase 4 trial. Lancet 381, 1541–1550 (2013).

    Article  CAS  PubMed  Google Scholar 

  5. Burmester, G. R. et al. Efficacy and safety of sarilumab monotherapy versus adalimumab monotherapy for the treatment of patients with active rheumatoid arthritis (MONARCH): a randomised, double-blind, parallel-group phase III trial. Ann. Rheum. Dis. 76, 840–847 (2017).

    Article  CAS  PubMed  Google Scholar 

  6. Taylor, P. C. Pain in the joints and beyond; the challenge of rheumatoid arthritis. Lancet Rheumatol. 5, e351–e360 (2023).

    Article  CAS  Google Scholar 

  7. Mariette, X. et al. Malignancies associated with TNF inhibitors in registries and prospective observational studies: a systematic review and metaanalysis. Ann. Rheum. Dis. 70, 1895–1904 (2011).

    Article  PubMed  Google Scholar 

  8. Ljung, L., Rantapää-Dahlqvist, S., Jacobsson, L. T. & Askling, J. Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis. Ann. Rheum. Dis. 75, 2087–2094 (2016).

    Article  CAS  PubMed  Google Scholar 

  9. Giles, J. T. et al. Cardiovascular safety of tocilizumab versus etanercept in rheumatoid arthritis: a randomized controlled trial. Arthritis Rheumatol. 72, 31–40 (2020).

    Article  CAS  PubMed  Google Scholar 

  10. Kristensen, L. E. et al. Identification of two tofacitinib subpopulations with different relative risk versus TNF inhibitors: an analysis of the open label, randomised controlled study ORAL Surveillance. Ann. Rheum. Dis. 82, 901–910 (2023).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter C. Taylor.

Ethics declarations

Competing interests

P.C.T. declares that he has received consulting fees from AbbVie, Biogen, Bristol Myers Squibb, Fresenius, Galapagos, Gilead Sciences, GSK, Janssen, Lilly, Nordic Pharma, Pfizer, Roche, Sanofi and UCB, and research support to the University of Oxford from Galapagos.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taylor, P.C. Are TNF inhibitors still the agent of choice for RA?. Nat Rev Rheumatol 19, 755–756 (2023). https://doi.org/10.1038/s41584-023-01043-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41584-023-01043-y

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing