Cover

TNF Pathophysiology

Molecular and Cellular Mechanisms

Editor(s): Kollias G. (Vari) 
Sfikakis P.P. (Athens) 
Table of Contents
Vol. 11, No. , 2010
Section title: Paper
Kollias G, Sfikakis PP (eds): TNF Pathophysiology. Molecular and Cellular Mechanisms. Curr Dir Autoimmun. Basel, Karger, 2010, vol 11, pp 180–210
(DOI:10.1159/000289205)

The First Decade of Biologic TNF Antagonists in Clinical Practice: Lessons Learned, Unresolved Issues and Future Directions

Sfikakis P.P.
First Department of Propedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece

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Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 2/18/2010
Cover Date: 2010

Number of Print Pages: 31
Number of Figures: 0
Number of Tables: 0

ISBN: 978-3-8055-9383-0 (Print)
eISBN: 978-3-8055-9384-7 (Online)

Abstract

Results from clinical trials of biologic anti-TNF drugs performed in the late 1990s confirmed the biological relevance of TNF function in the pathogenesis of chronic noninfectious inflammation of joints, skin and gut, which collectively affects 2–3% of the population. Up to April 2009, more than two million patients worldwide have received the first marketed drugs, namely the monoclonal anti-TNF antibodies infliximab and adalimumab and the soluble TNF receptor etanercept. All three are equally effective in rheumatoid arthritis, ankylosing spondylitis, psoriasis and psoriatic arthritis, but, for not clearly defined reasons, only the monoclonal antibodies are effective in inflammatory bowel disease. About 60% of patients who do not benefit from standard nonbiologic treatments for these diseases respond to TNF antagonists. Less than half of responding patients achieve complete remission of disease. Importantly, some of those patients with rheumatoid arthritis in whom long-term anti-TNF therapy induced disease remission remain disease-free after discontinuation of any kind of treatment. There are not yet reliable predictors of which patients will or will not respond on anti-TNF therapy, whereas subsequent loss of an initial clinical response occurs frequently. The spectrum of efficacy anti-TNF therapies widens to include diseases such as systemic vasculitis and sight-threatening uveitis. While paradoxical new adverse effects are recognized, i.e. exacerbation or development of new onset psoriasis, reactivation of latent tuberculosis remains the most important safety issue of anti-TNF therapies. Clinical practice guidelines and consensus statements on the criteria of introduction, duration of treatment and cessation of TNF antagonists, including safety issues, are under constant revision as data from longer periods of patient exposure accumulate. It is hoped that more efficacious drugs that will ideally target the deleterious proinflammatory properties of TNF without compromising its protective role in host defense and (auto)immunity will be available in the near future.


  

Author Contacts

Petros P. Sfikakis, MD, PhD, First Department of Propedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, 17, Ag Thoma Street, GR–11527 Athens (Greece), Tel. +30 210 7258555, Fax +30 210 7485965, E-Mail psfikakis@med.uoa.gr

  

Article Information

Number of Print Pages : 31

  

Publication Details

Book Serie: Current Directions in Autoimmunity, Vol. 11, Year 2010

Editor(s): Kollias, G. (Vari); Sfikakis, P.P. (Athens)
ISSN: 1422-2132 (Print), eISSN: 1662-2936 (Online)

For additional information:
http://content.karger.com/ProdukteDB/produkte.asp?issn=1422-2132

Book Title: TNF Pathophysiology (Molecular and Cellular Mechanisms)

Editor(s): Kollias G, Sfikakis PP (eds)

For additional information:
http://content.karger.com/ProdukteDB/produkte.asp?issn=1422-2132&volume=11


Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 2/18/2010
Cover Date: 2010

Number of Print Pages: 31
Number of Figures: 0
Number of Tables: 0

ISBN: 978-3-8055-9383-0 (Print)
eISBN: 978-3-8055-9384-7 (Online)


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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