Results. Patients assigned to receive MTX and pamapimod had similar demographics and baseline characteristics. At week 12, fewer patients taking pamapimod had an ACR20 response (23%, 18%, and 31% in the 50-, 150-, and 300-mg groups, respectively) compared with patients taking MTX (45%). Secondary efficacy end points showed a similar pattern. AEs were typically characterized as mild and included infections, skin disorders, and dizziness. Pamapimod was generally well tolerated, but the 300-mg dose appeared to be more toxic than either the 2 lower doses or MTX.Conclusion. The present results showed that pamapimod was not as effective as MTX in the treatment of active RA.Parenteral biologic therapies that selectively neutralize proinflammatory cytokines such as tumor necrosis factor ␣ (TNF␣) and interleukin-1 (IL-1) or their receptors, such as the IL-6 receptor, substantially improve signs and symptoms of rheumatoid arthritis (RA), reduce the number of swollen and tender joints, and ClinicalTrials.gov identifier: NCT00303563.