Over the last decade, the use of tumor necrosis factor (TNF) inhibitors has improved the prognosis of patients with rheumatoid arthritis. Although these agents are more efficacious than traditional DMARDs, a substantial proportion of patients discontinue anti-TNF therapy because of adverse effects or lack of efficacy. Therapeutic options for these patients include dose increases, switching to an alternative TNF antagonist, or switching to a biologic of a different class, such as rituximab or abatacept. The recently published results of the RADIATE study by Emery et al. suggest that the interleukin-6 inhibitor tocilizumab is a safe and effective alternative for patients who fail to respond to anti-TNF therapy. Randomized controlled trials and the study of biomarkers are needed to help clinicians select the most suitable of these options for their patients.