Other immunomodulatory treatments should be avoided due to the potential for additive immunosuppressant effects, or in the case of immunostimulants like echinacea or astragalus, reduced therapeutic effects. Likewise live vaccines (like haemophilus influenzae type b vaccine and yellow fever vaccines) should be avoided due to the potential for severe infection due to the immunosuppressive nature of the treatment. The concomitant use of methotrexate, in particular, may lead to severe or even fatal liver-damage or hepatotoxicity. Seventy-five percent of all cases of severe liver damage reported until early 2001 were seen under combined drug therapy<unk>  plus methotrexate. However, some studies have shown that the combination of methotrexate and<unk>  in patients with rheumatoid arthritis gave better results than either drug alone.
Leflunomide
Tofacitinib
Etanercept
Teriflunomide
Belatacept
Belimumab
Adalimumab
Anakinra