In 2015 the American College of Rheumatology released treatment guidelines for RA, formulated by group of rheumatologists. The new recommendations say if the patient fails one TNF biologic, they can try another TNF biologic or try a different type of biologic depending on other diseases and conditions they have. Dr. Christopher Ritchlin noted that one of the more surprising recommendations is that patients who fail the first TNF may switch to a biologic of a different class. Dr. Michael Pillinger says all biologics are good, though some are more likely to cause infection, and these are things to consider as doctors personalize treatment for individual patients. It’s important to understand each patient’s reason for discontinuing the TNF, their preferences and other comorbidities before deciding which drug to prescribe.

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