WHO Collaborating Centre consensus meeting on anti-cytokine therapy in rheumatoid arthritis

Severe adult rheumatoid arthritis is a cause of progressive disability and increased mortality across Europe. A cure for the disease remains elusive, but control of symptoms and maintenance of individual independence is possi ble. Anti-cytokine therapies offer a new approach to disease management. Th ey are effective after the failure of full doses of methotrexate, and are a t least as effective as methotrexate in retarding the progression of radiol ogical changes. Until more is known about the long-term safety and efficacy of these drugs they should be reserved for patients with severe disease wh o are progressing despite adequate doses of methotrexate or other disease-m odifying anti-rheumatic drugs. They should be continued until therapeutic f ailure or intolerance. A comprehensive health economic evaluation is needed to optimally direct the use of these drugs. This should be undertaken when long-term safety and efficacy studies are completed.