[Effective combination therapy of TNF antagonists with DMARDs].

Efficacy and safety of anti-tumor necrosis factor (TNF) antagonists (infliximab, etanercept, adalimumab) in combination with methotrexate for rheumatoid arthritis is well determined. But methotrexate is not tolerable nor effective in some cases. Leflunomide in combination with anti-TNF antagonists is the alternative combination therapy in the world. But unfortunately, leflunomide itself is not tolerable for some Japanese cases because of fatal interstitial pneumonitis. A prospective open-label study of sulfasalazine, hydroxychloroquine, intramusculer gold in combination with etanercept indicated the efficacy and tolerability. Azathiopurine and bucillamine may be used when methotrexate is not effective or intolerable, although they need more examination.