antyTNF

Anti-TNF therapy comprises medications that inhibit tumor necrosis factor, a pro-inflammatory cytokine involved in many autoimmune diseases. They are a major class of biologic disease-modifying antirheumatic drugs (biologic DMARDs) used to reduce inflammation.

Mechanism and agents: Anti-TNF drugs are monoclonal antibodies or receptor fusion proteins that neutralize TNF or block its interaction with TNF receptors. Available agents include infliximab, adalimumab, golimumab, certolizumab pegol, and etanercept. They differ in their targets and how they are administered, with some molecules binding TNF in its soluble form and others acting as decoys for TNF.

Indications: Anti-TNF therapy is used for a range of inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondyloarthritides, Crohn's disease, ulcerative colitis, plaque psoriasis, and certain forms of juvenile idiopathic arthritis and uveitis.

Administration and monitoring: Infliximab is given by intravenous infusion, while the others are administered by subcutaneous injection. Dosing varies by drug and condition. Before starting therapy, patients are typically screened for latent tuberculosis and hepatitis B. Monitoring includes checking for infections, liver enzymes, and blood counts, and assessing for signs of heart failure or demyelinating events. Co-prescribing methotrexate or another immunosuppressant can improve response and reduce antibody formation against the biologic.

Safety and considerations: Common adverse effects include injection or infusion reactions and infections. Serious risks include serious infections, reactivation of latent tuberculosis, and in some cases potential malignancies, particularly with long-term use in certain populations. Vaccination status should be reviewed, and live vaccines are usually avoided during therapy.

History and impact: Anti-TNFs were introduced in the late 1990s and have since transformed management of many inflammatory diseases, with biosimilars helping to broaden access in many regions.