Safety overview of new disease-modifying antirheumatic drugs

The use of novel DMARDs (leflunomide, anakinra, TNF inhibitors) has produced newfound levels of patient satisfaction. The toxicities detailed herein are often mild to moderate, often resolve or are well tolerated, and seldom warrant discontinuation of the drug. Serious and potentially life-threatening adverse events are rare, even in the postmarketing era. Clinicians should be mindful of these rare adverse events (eg, tuberculosis or lymphoma) and should counsel patients appropriately based on their concerns and quality of life. Because many of these serious toxicities occur at rates of 1 or fewer cases per 1000 patient years of use, it appears that proper patient selection and prevention measures are needed to further limit this risk.