Tocilizumab (TCZ) and tumour necrosis factor inhibitors (TNFi) are recommended 
for the treatment of rheumatoid arthritis (RA) in patients with inadequate 
response (IR) to prior disease-modifying antirheumatic drugs (DMARDs). This 
retrospective analysis assessed the efficacy of TCZ and TNFi, alone or in 
combination with DMARDs, in 1603 patients with IR to previous treatment with 
either DMARDs (DMARD-IR) and/or TNFi (TNFi-IR), initiating treatment with TCZ or 
a TNFi, managed in routine clinical practice. Patients were grouped according to 
treatment history and treatment initiated: DMARD-IR patients initiating 
treatment with TCZ + DMARD (DMARD-IR TCZ) or TNFi + DMARD (DMARD-IR TNFi), 
DMARD-IR and/or TNFi-IR patients initiating treatment with TCZ monotherapy (TCZ 
mono) or TNFi monotherapy (TNFi mono), and TNFi-IR patients initiating treatment 
with TCZ + DMARD (TNFi-IR TCZ) or TNFi + DMARD (TNFi-IR TNFi). Patients 
initiating treatment with TCZ generally had more severe disease and longer 
disease duration compared with the corresponding TNFi group. Significantly more 
patients achieved remission (DAS28 ESR <2.6) in the TCZ groups compared with 
corresponding TNFi groups (DMARD-IR, TCZ 44.0 % vs. TNFi 29.6 %; monotherapy, 
TCZ 37.2 % vs. TNFi 30.2 %; TNF-IR, TCZ 41.3 % vs. TNFi 19.2 %; p < 0.001 for 
all comparisons). More patients achieved moderate-good responses (EULAR 
criteria) in the TCZ treatment groups (79-85 %) compared with TNFi treatment 
groups (65-81 %). Patient-reported outcomes showed greater improvements in TCZ 
compared with TNFi groups. In patients with inadequate response to DMARDs and/or 
TNFi treated in routine clinical practice, TCZ in combination with DMARDs or as 
monotherapy resulted in significantly more patients achieving remission and more 
marked improvements in patient-reported outcomes compared with TNF inhibitors.