Consensus statement on the initiation and continuation of tumour necrosis factor blocking therapies in rheumatoid arthritis

This group of rheumatologists gathered in Vienna out of concern about the absence of a uniform view and guidance on the introduction of tumour necrosis factor (TNF)-blocking therapies in our clinics. With our growing experience, evaluation of drug treatment of rheumatoid arthritis (RA), and previous participation in consensus statements,1 we have had the opportunity of discussing the accrued knowledge as well as personal experiences in the use of TNF-blocking agents and of formulating our jointly shared views on: For the present, TNF blockade should be reserved for patients with RA whose symptoms and signs are resistant to disease modifying antirheumatic drug (DMARD) treatment. It is generally agreed that all patients with active disease should be treated with DMARDs, as such treatment ameliorates symptoms and slows progression of structural damage.2 However, long term efficacy of DMARDs is limited and toxicity accumulates.3 Currently, two TNF-blocking agents, etanercept and infliximab, have received regulatory authority approval for the treatment of RA. Both compounds, alone or in combination with methotrexate, have proved to be successful in significantly reducing inflammatory activity …