RADIATE: more treatment options for patients with an inadequate response to tumor necrosis factor antagonists

Over the last decade, the use of tumor necrosis factor (TNF) inhibitors has improved the prognosis of patients with rheumatoid arthritis. Although these agents are more efficacious than traditional DMARDs, a substantial proportion of patients discontinue anti-TNF therapy because of adverse effects or lack of efficacy. Therapeutic options for these patients include dose increases, switching to an alternative TNF antagonist, or switching to a biologic of a different class, such as rituximab or abatacept. The recently published results of the RADIATE study by Emery et al. suggest that the interleukin-6 inhibitor tocilizumab is a safe and effective alternative for patients who fail to respond to anti-TNF therapy. Randomized controlled trials and the study of biomarkers are needed to help clinicians select the most suitable of these options for their patients.