Findings from Finckh et al., 2007 suggest that rituximab may be a better treatment to rheumatoid arthritis (RA) patients who made use of a previous anti-TNF agent. The results from Hyrich et al, 2007 point out that the reasons for RA patients stopping a second drug are related to the reasons for stopping the first drug. OBJECTIVES: To picture the scenario of the usage of anti-TNFs as 2nd line therapy for RA patients in the public health care sector in Brazil. To calculate the economic impact of rituximab incorporation as 2nd line RA therapy. METHODS: A database analysis on the use of anti-TNFs as 2nd line therapy for RA patients was conducted for the total period (November 2006-january 2009) available at DATASUS (www.datasus.gov.br) the government public database. We were able to identify the therapeutic pathways of 5018 patients up to December 2007. About 2.5% (122 patients) performed a switch to a second anti-TNF agent.  An increasing in the use of anti-TNFs as 2nd line therapy was also identified. Then the current economic impact of anti-TNF treatment switches was calculated. Later, we substituted the second-line anti-TNF agents used for rituximab and compared the results. Drug costs were obtained from ’Banco de Preços em Saúde’ (http://portal.saude.gov.br/bps/), the government official source. RESULTS: The use of anti-TNFs as 2nd line therapy for RA patients in the public health care sector in Brazil is a reality with a growing trend in Brazil. The use of rituximab, as a replacement of a second anti-TNF agent for RA patients, has the potential of offering savings of about R$2.5 million for the public health care sector. CONCLUSIONS: The use of rituximab, as a replacement for anti-TNFs agents as 2nd line therapy for RA patients, could increase the clinical benefits for RA patients and bring savings of about R$ 2,5 million for Brazilian public healthcare system.