Rheumatoid arthritis: beyond tumor necrosis factor-alpha antagonists, B cell depletion, and T cell blockade

Significant advances have been made in the treatment of rheumatoid arthritis (RA). For instance, novel biologic therapeutics capable of blocking tumor necrosis factor-alpha (TNF-alpha) have improved outcomes for RA patients. New therapeutic agents directed at antagonizing two previously untargeted pathways have recently been approved by the U.S. Food and Drug Administration for RA patients who have had inadequate responses to anti-TNF therapy or who have failed to maintain an adequate clinical response. We review the data supporting the use of these agents, rituximab and abatacept.