Anti-TNF-α Inhibitors: A New Therapeutic Approach for Inflammatory Immune-Mediated Diseases: An Update upon Efficacy and Adverse Events

Abstract

The ongoing progresses in the knowledge of the pathogenic mechanisms of various inflammatory or immune-mediated diseases and the availability of innovative biotechnological approaches have lead to the development of new drugs which add to conventional treatments. TNF-α inhibitors (Infliximab, Adalimumab and Etanercept) have demonstrated efficacy either as monotherapy or in combination with other anti-inflammatory or disease modifying anti-rheumatic drugs (DMARDs). The efficacy and safety profile of the TNF-α inhibitors can be considered, in general, as a class effect. Nevertheless, some differences may exist among the three agents. In this paper, we will briefly review the indications for the use of the three TNF-α inhibitors, the pre-treatment considerations and the reported adverse events.

Autoimmune central diabetes insipidus in a patient with ureaplasma urealyticum infection and review on new triggers of immune response

“…After treatment with intravenous cyclophosphamide and concomitant oral prednisone, AVPc antibodies disappeared, CDI improved and vasopressin replacement therapy was completely withdrawn. Finally, TNF-α inhibitors appeared efficient in the treatment of chronic immune-mediated or inflammatory diseases, such as rheumatoid arthritis, ankylosing spondylitis, psoriasis and/or psoriatic arthritis (25)(26)(27)(28)(29)(30)(31). Which may be their potential effectiveness in treating autoimmune CDI, is a question that remains unanswered so far.…”

Update upon efficacy and safety of TNF-α inhibitors

“…A small number of Histoplasma capsulatum, Coccidioides immitis, Listeria monocytogenes, invasive fungal (candidiasis and aspergillosis) infections, retropharyngeal abscesses and palmoplantar pustulosis have been reported [27]. Some cases of Pneumocystis jiroveci (carinii) pneumonia and a case of visceral leishmaniasis have been reported [27].…”

“…Some cases of Pneumocystis jiroveci (carinii) pneumonia and a case of visceral leishmaniasis have been reported [27]. The most frequent potential adverse events of TNF-a inhibitor drugs are: i) infusion reactions with infliximab and ii) injection-site reactions to subcutaneously administered drugs.…”

“…MTX is usually coadministered to control both the rheumatic disease and the development of neutralizing antibodies [3]. In spite of its fully human sequence, the production of antibodies to adalimumab has been also reported, which may reduce the efficacy of the drug and induce the development of adverse drug reactions and exanthema [7,27]. Malignancies (i.e., lymphomas), autoimmune diseases and demyelinating diseases have been reported.…”

“…Malignancies (i.e., lymphomas), autoimmune diseases and demyelinating diseases have been reported. Nevertheless, there is evidence that in RA patients the risk for lymphoma is irrespective of treatment [27] and there were no reported cases of hepatosplenic T-cell lymphoma in patients with inflammatory bowel disease who receive only TNF-a inhibitors [28].…”