Consequently, it was recommended as an option for patients with severe RA who can tolerate MTX if: (1) they have cDMARD inadequate response; (2) they have an anti-TNF inadequate response and rituximab (RTX) in combination with MTX is not an option; or (3) they have an anti-TNF inadequate response and have already been treated with RTX. Here, TNF is linked to rheumatoid arthritis.