TNF and macrophage activation syndrome: However, Hashkes et al. (8) commented on 6 deaths, all in children treated with combined DMARDs, including anti–TNF-α agents, and associated with serious infections: 3 treated with etanercept (1 each with suspected sepsis, MAS, and tuberculosis [previously treated with infliximab]); 2 with infliximab (sepsis); and 1 with adalimumab (MAS and interstitial pneumonia).