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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Patients are often advised to weigh the benefit and risk of any arthritis medication. In the case of TNF blockers, what are the benefits and risks which should be considered? Are there individual differences between Enbrel, Remicade, and Humira in terms of benefits or risks?

A. The TNF blockers Enbrel (etanercept), Remicade(infliximab) and Humira (adalimumab) have been a tremendous benefit in the treatment of rheumatoid arthritis. They are effective in over 70% of patients including many who have not responded to methotrexate - considered by many clinicians to be the gold standard of rheumatoid arthritis treatment.

While methotrexate may take 8 weeks or more to achieve benefit, many patients see benefit from TNF blockers within two weeks. In addition, they are also very effective in relieving the fatigue that is a common symptom.

Like all medications, TNF blockers have potential side effects such as an increased risk of infection including unusual infections such as tuberculosis (TB). Enbrel is less commonly associated with TB than the other two medications.

Unlike most medications, the TNF blockers are not effective orally and must be given as a subcutaneous injection (under the skin) once or twice a week with Enbrel and every other week with Humira. Remicade is given as an intravenous infusion every 4-8 weeks. Because Remicade is given intravenously, it can be associated with an allergic reaction that can be life threatening in up to 1% of patients.

Finally, these drugs are very expensive. Cost can vary based on a patient's insurance coverage. If insurance is not considered, the cost of a year of Remicade can sometimes be double that of Humira or Enbrel.

Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of Anti-TNF Blockers. The book is a must-have for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book.