The anti-TNF agents have been demonstrated to provide a marked improvement in outcomes in a proportion of patients with rheumatoid arthritis. Furthermore, they are well tolerated. Injection site reactions or infusion-related reactions are relatively common but easily managed and rarely lead to discontinuation of therapy. These drugs do lead to an increased incidence of upper respiratory tract infections and more rarely to serious opportunistic or tuberculous infections. With appropriate screening, some infections can be prevented and those that do occur generally respond to appropriate medical treatment. However, it is important to emphasize the value of screening, education, and monitoring of patients. Overall, the anti-TNF biologics have demonstrated a risk-benefit profile that markedly favours an overall benefit.
IL-1 inhibitors have been less successful in the clinic but nonetheless clinical trials have validated IL-1 as a target for therapy in rheumatoid arthritis. New pharmacological approaches to IL-1 blockade are under investigation but current evidence strongly contraindi-cates dual blockade of IL-1 and TNF on the basis of no observed additional benefit and a considerable increase in risk of infective complications.
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