TNF and rheumatoid arthritis: It is important to note that up to 40% of all RA patients treated with Anti-TNF drugs fail to respond adequately to these agents or lose responsiveness over time, which might support the ACR decision.53 A meta-analysis of randomised controlled trials comparing responses to different bDMARDs in patients who failed TNF inhibitors concluded that tocilizumab was the best alternative in these patients, followed by Rituximab, Abatacept, and tofacitinib.54