Management for TNF failure

: At the dawn of biologics era, we just have strong weapons against rheumatoid arthritis (RA). After the introduction of anti-tumor necrosis factor (TNF) agents (infliximab, etanercept, and adalimumab), we have experienced the revolutional effects on the treatment for RA. In spite of these excellent effects, there are a proportion of patients refractory to these agents. While we can choose another anti-TNF agent for them at present, many biologics for other targets such as CTLA4 (abatacept), IL-6 (tocilizumab), and CD20 (rituximab) are on the waiting list in the very near future. These agents have been reported to have the strong efficacy to TNF failure patients with RA. After developing many agents for the pathophysiologic targets of RA, we will expect to select one of them for each patient dependent on their predictive value of RA in the future.