Drug		Mechanism for rheumatoid arthritis	Adverse effects	Typical dosage	Cost*
Nonbiologic†
Methotrexate		Inhibits dihydrofolate reductase	Liver effects, teratogenesis, hair loss, oral ulcers	Up to 25 mg orally or subcutaneously every week	$60 for 40 2.5-mg tablets $10 for one 2-mL vial (25 mg per mL)
Leflunomide (Arava)		Inhibits pyrimidine synthesis	Liver effects, gastrointestinal effects, teratogenesis	10 to 20 mg orally every week	$30 ($175)
Hydroxychloroquine (Plaquenil)		Antimalarial, blocks toll-like receptors	Rare ocular toxicity	200 to 400 mg daily	$55 ($210)
Sulfasalazine (Azulfidine)		Folate depletion, other mechanisms unknown	Anemia in glucose-6-phosphate dehydrogenase deficiency, gastrointestinal effects	500 to 1,500 mg twice per day	$15 ($90)
Biologic
Anti-TNF agents
	Adalimumab (Humira)	Anti-TNF-α	TB, opportunistic infection	40 mg subcutaneously every two weeks	NA ($4,500)
	Certolizumab pegol (Cimzia)	Anti-TNF-α, pegylated	TB, opportunistic infection	400 mg subcutaneously every four weeks	NA ($4,000)
	Etanercept (Enbrel)	Anti-TNF-α, receptor	TB, opportunistic infection	50 mg subcutaneously every week	NA ($4,500)
	Golimumab (Simponi)	Anti-TNF-α	TB, opportunistic infection	100 mg every four weeks	NA ($4,900)
	Infliximab (Remicade)	Anti-TNF-α	TB, opportunistic infection, infusion reaction	3 to 5 mg per kg intravenously every six to eight weeks	NA ($2,500) for two 100-mg vials
Other biologic agents
	Abatacept (Orencia)	Costimulator blocker, cytotoxic T lymphocyte antigen 4	Opportunistic infection	125 mg subcutaneously every week, or 500 to 1,000 mg intravenously every four weeks	NA ($4,000)
	Anakinra (Kineret)	Anti-interleukin-1 receptor blocker	Opportunistic infection, injection site pain	100 mg subcutaneously daily	NA ($4,000)
	Rituximab (Rituxan)	Anti-CD20, eliminates B cells	Infusion reaction, opportunistic infection, progressive multifocal leukoencephalopathy	1,000 mg intravenously every six months	NA (> $5,000‡)
	Sarilumab (Kevzara)	Anti-interleukin-6 receptor blocker	Opportunistic infection	150 to 200 mg subcutaneously every two weeks	NA ($2,700)
	Tocilizumab (Actemra)	Anti-interleukin-6 receptor blocker	Opportunistic infection, hyperlipidemia	4 to 8 mg per kg intravenously every four weeks, or 162 mg subcutaneously every week or every two weeks	NA ($2,000) for one 20-mL vial (20 mg per mL)
	Tofacitinib (Xeljanz)	Janus kinase inhibitor	TB, opportunistic infection	5 mg daily or twice per day, or 11 mg daily extended release	NA ($2,000) NA ($4,000) for extended release