Update on Anti-TNF-Alpha Treatment in Rheumatic Diseases

Marco      Massarotti; Antonella      Ferrara; Bianca      Marasini

Abstract

The development of inhibitors of Tumor Necrosis Factor (TNF)α ro-inflammatory cytokine playing a pivotal role in chronic inflammatory diseases, represents a milestone in the therapy of several rheumatic diseases. Currently, three TNFα -blo drugs are available for clinical use in rheumatic diseases: infliximab, etanercept and adalimumab. These drugs rapidly reduce disease activity and probably change the poor outcome of several chronic rheumatic diseases, by preventing the development of bone erosions, joint deformity and disability. Although these drugs have proved to be effective and well tolerated in the short period, some concerns exist about long-term safety and efficacy. In fact, the longterm use of inhibitors of TNFα,a pivota okine in host defense, might result in the development of infections and neoplasms, therefore the long-term safety has to be defined. The most frightening infection to date is tuberculosis, and guidelines for the screening of patient candidates to biological treatment has significantly reduced the risk. Parasitic and viral infections do not contraindicate biological therapy. Lymphoma has been reported in association with TNFα antagonists, h ether or not there is a causal relationship is still debated. The use of biological agents in other rheumatic inflammatory conditions is rapidly increasing, but their cost poses a considerable financial burden on healthcare systems and a careful economic evaluation is needed. /abs >

Keywords: Etanercept, infliximab, adalimumab, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis

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