In a review of its 2008 guidance, the institute has ruled that abatacept, in combination with methotrexate, can be considered for adults with severe active rheumatoid arthritis who are unresponsive or intolerant to a DMARD (including at least one TNF inhibitor) and in whom rituximab is unsuitable.
Adalimumab, etanercept and infliximab are recommended as other treatment options alongside abatacept.