Anti-Tumour Necrosis Factor-Alpha (TNF-α) Treatment

Abstract

There are currently five TNF-α inhibitors available to treat inflammatory arthropathies. These can be subdivided into first generation agents (comprising etanercept, infliximab and adalimumab) and second generation agents (comprising certolizumab and golimumab). In RA all TNF-α inhibitors are nationally approved for use in routine clinical care. There is no evidence that one of these agents is superior to another and practical and financial issues determine which is chosen. In other forms of inflammatory arthritis, in particular in AS, there is evidence that some biologics may be less effective than others. Overall, there is strong clinical trial evidence for their efficacy in inflammatory arthritis. Although relatively safe, TNF-α inhibitors have a broad range of potential adverse effects. The dominant risk is an increased infection risk, particularly that of latent tuberculosis reactivation. This chapter will provide an overview of the available TNF-α inhibitors, their mechanisms of action, the evidence base for their efficacy and the potential adverse events associated with them.