TNF and rheumatoid arthritis: Furthermore, a postmarketing surveillance study in patients with active RA recently reported that the risk of major adverse cardiovascular events, malignancy, thrombosis and death with tofacitnib was numerically higher compared with TNF inhibitors.10 This observation has led to warnings regarding the use of JAK inhibitors from the United States Food and Drug Administration and the European Medicines Agency.11 12 Therefore, there is an unmet need for a new treatment option with a different mechanism of action in RA.