Table 1.

Summary of Biological DMARDs Used in Rheumatoid Arthritis

Drug Class	Efficacy (ACR70*)	Adverse Effects	Contraindications^
TNF-α inhibitor
Adalimumab 40mg SC fortnightly	20–21% (MTX inadequate responders)6,8,9 12% (TNFi inadequate responders)12	Infections, TB reactivation, injection site reactions, hypersensitivity reactions, LFT derangements, psoriasis, drug-induced lupus, blood dyscrasias, malignancy (non-melanomatous skin cancers, lymphoma), exacerbation demyelinating disease, exacerbation of heart failure	Serious or untreated infections including TB, current malignancy, multiple sclerosis, severe heart failure, hypersensitivity
Certolizumab pegol 200mg SC fortnightly
Etanercept 50mg SC weekly or 25mg twice weekly
Golimumab 50–100mg SC monthly
Infliximab 3–10mg/kg IV 4–8 weekly
IL-6 inhibitor
Tocilizumab 162mg SC weekly or 8mg/kg IV monthly	22% (MTX inadequate responders)24 12% (TNFi inadequate responders)21	Infections, injection site reactions, hypersensitivity reactions, LFT derangements, hyperlipidaemia, neutropenia, diverticulitis and GI perforation	Serious or untreated infections, hypersensitivity, diverticulitis
Sarilumab 150–200mg SC fortnightly
CD20 depleting antibody
Rituximab IV 2 course dose 500–1000mg, repeat after >6 months	20% (MTX inadequate responders)67 12% (TNFi inadequate responders)68	Infections, hypersensitivity reactions, cytopaenias, hepatitis B reactivation, progressive multifocal leukoencephalopathy	Serious or untreated infections including hepatitis B, hypersensitivity
CD80/86 costimulation inhibitor
Abatacept 125mg SC weekly or IV infusion	21% (MTX inadequate responders)18 10% (TNFi inadequate responders)19	Infections, hypersensitivity reactions, infusion reactions, leukopenia, bronchitis	Serious or untreated infections, current malignancy, hypersensitivity
IL-1 inhibitor
Anakinra 100mg SC daily	7% (either MTX naïve or MTX inadequate responders)27	Infections, injection site reactions	Serious or untreated infections, hypersensitivity

Notes: Drug dosing, adverse effect profile and contraindications were adapted from the Australian Medicine Handbook⁶⁹. The adverse effects listed are a selective and far from an exhaustive list. *ACR70 is a composite measure defined as an improvement of at least 70% in the number of tender and number of swollen joints, and at least a 70% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure, visual analogue pain scale, and erythrocyte sedimentation rate or C-reactive protein. ACR70% response rates correspond with a state of either remission or low disease activity and are used as surrogates of low disease activity. ^{^}Absolute or relative.