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Unregulated prescribing of anti-tumour necrosis factor agents does not mean inappropriate prescribing
  1. C T Ng1,
  2. B J Radovits1,2,
  3. W Kievit2,
  4. J Fransen2,
  5. P L C M van Riel2,
  6. O FitzGerald1,
  7. D J Veale1,
  8. B Bresnihan1
  1. 1
    Dublin Academic Health Care, St Vincent’s University Hospital, Dublin, Ireland
  2. 2
    Radboud University Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Professor B Bresnihan, Department of Rheumatology, Bone and Joint Unit, St Vincent’s University Hospital, Dublin Academic Health Care, Elm Park, Dublin 4, Ireland; barry.bresnihan{at}gmail.com

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Treatment with anti-tumour necrosis factor (anti-TNF) agents has consistently improved the clinical features of rheumatoid arthritis (RA).1 They reduce the rate of articular damage and loss of physical function and enable continuance at work.2 There is evidence to suggest that, despite their high price, anti-TNF agents may be cost-effective3 4 and data from large national registries have highlighted long-term safety.5

In many countries the availability of anti-TNF agents is strictly regulated and there is a variability in the framework for its initiation across Europe.6 Between 1999 and 2008, rheumatologists in the Republic of Ireland could freely prescribe anti-TNF agents under a …

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