Transcript Prescribing Algorithms for Anti

Rheumatoid Arthritis
Normally initiated with the least
expensive drug (taking into account
administration costs required dose and
product price per dose). This may need
to be varied in individual cases due to
differences in the mode of
administration and treatment schedules
Patient has tried two 6-month
courses of DMARDs
Patient meets NICE criteria to start Anti-TNFα
DASI28 >5.1 on two occasions 1
month apart
If ADR within 6 months,
switch to either
Certolizumab
+ Mtx
Adalimumab
Etanercept
Infliximab
+ Mtx
+ Mtx
+ Mtx
1st
line
Mono only if
Mtx
inappropriate
or ADR
Golimumab
+Mtx
Adalimumab
Etanercept
Tocilizumab
mono
mono
+ Mtx
If inadequate
response, or
development
of intolerance
2nd line if Rituximab C/I or ADR
Rituximab
+ Mtx
2nd
line
If inadequate
response, or
development
of intolerance
3rd
line
Tocilizumab
+ Mtx
Abatacept
Etanercept
Infliximab
+Mtx
+Mtx
+ Mtx
Adalimumab
Etanercept
mono
mono
Adalimumab
Golimumab
Tocilizumab
+ Mtx
+ Mtx
+ Mtx
2nd line if Mtx C/I or ADR
N.B. Continue Biologics only where benefit is demonstrated