Aspects of TNF inhibitor therapy in rheumatoid arthritis

Treatment outcomes in rheumatoid arthritis (RA) have improved considerably with the use of biological therapies. Since the discovery of the role of tumor necrosis factor (TNF) alpha in the pathogenesis of the disease, three TNF inhibitors, infliximab, etanercept and adalimumab, have become widely used for the treatment of RA. More recently, two newer TNF inhibitors-certolizumab pegol and golimumab-have become available, increasing the armamentarium of therapy. With improved therapies, treatment strategies have also changed, with the aims now being to achieve and maintain remission. This article addresses some of these aspects of treating RA, reviewing the studies on these two newer TNF inhibitors, certolizumab pegol and golimumab, and those addressing the induction of remission or low disease activity with TNF inhibitors and maintenance with less intensive treatment.