EDITORIAL
Rheumatoid arthritis
Differential drug resistance to anti-tumour necrosis factor agents in rheumatoid arthritis
Departments of Internal Medicine and Rheumatology, Clinical Immunology and Allergy, University of Crete, University Hospital, Voutes 71110 Heraklion, Greece
Correspondence to:
Correspondence to:
Professor D T Boumpas
boumpasd@med.uoc.gr
A significant number of patients receiving infliximab require dosing adjustments while some patients may indeed develop drug resistance
Keywords: rheumatoid arthritis; anti-tumour necrosis factor agents; drug resistance; antirheumatic therapy
| The first 150 words of the full text of this article appear below. |
Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease that leads to progressive joint destruction and disability. New biological drugs have been added to our armamentarium since 1999, including agents targeting tumour necrosis factor 
(TNF). Among them, infliximab, etanercept, and adalimumab in randomised controlled trials (RCTs), reduced signs and symptoms of RA and protected joints from structural damage more effectively than conventional disease modifying antirheumatic drugs (DMARDs).1–3 However, residual disease activity remains a considerable problem and remissions are seen in <30% of patients with established disease.4
To date, head-to-head comparisons among anti-TNF agents do not exist, in part because of the large sample size required to demonstrate either differences between, or equivalence of, treatments. In the absence of head-to-head randomised comparisons of anti-TNF agents, claims that one drug is better than the others have been met with scepticism by practising physicians. They generally view these drugs as
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