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Published on: September 16, 2017
The benefit/risk profile of TNF-blocking agents: findings of a consensus panel
Marc C Hochberg1, Mark G Lebwohl, Scott E Plevy
1Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore 21201, USA. mhochber@umaryland.edu
Insights
Tumor necrosis factor (TNF)-blockers are effective for rheumatoid arthritis and Crohn's disease. Careful monitoring helps manage risks like infections and heart failure, ensuring safe short- and long-term use.
Area of Science:
- Immunology and Pharmacology
- Rheumatology and Gastroenterology
Background:
- Review of tumor necrosis factor (TNF)-blockers for rheumatoid arthritis (RA), Crohn's disease (CD), and psoriasis.
- Assessment of benefits and risks of TNF-blockers in various autoimmune conditions.
Framework:
- Consensus panel review of peer-reviewed articles and emerging data.
- Inclusion of clinical studies and real-world clinical experiences with TNF-blockers.
Implementation:
- TNF-blockers (infliximab, etanercept, adalimumab) are effective for RA; no head-to-head trials favor one agent.
- Infliximab is approved for CD induction/maintenance; etanercept and infliximab show promise for psoriasis.
- Management strategies for identified risks including infections, heart failure, and infusion reactions.
Implications:
- TNF-blockers offer safe and effective short- and long-term management for RA and CD.
- Potential for TNF-blockers in other emerging indications requires further investigation.
- Risk management through screening and vigilant monitoring is crucial for patient safety.
Objective:
To review the benefits and risks associated with the use of the tumor necrosis factor (TNF)-blockers in various indications (eg, rheumatoid arthritis [RA], Crohn's disease [CD], psoriasis).
Methods:
The members of the consensus panel were selected based on their expertise. Centocor, Inc provided an educational grant to the Center for Health Care Education to facilitate the consensus panel. Peer-reviewed articles discussing clinical studies and clinical experiences with TNF-blockers form the basis of this review. Emerging data that have not been peer-reviewed are also included.
Results:
The TNF-blockers infliximab, etanercept, and adalimumab are all approved for treatment of RA. All 3 are effective, and there are currently no published data from head-to-head clinical trials to support using 1 agent over another. Preliminary data from small, retrospective studies indicate that switching among agents to overcome inadequate efficacy or poor tolerability is beneficial in some patients. The only TNF-blocker currently approved for the induction and maintenance of remission in CD is infliximab. Preliminary data indicate that etanercept and infliximab are effective in treating psoriasis. Some risks associated with TNF-blockers have become apparent, including congestive heart failure, demyelinating diseases, and systemic lupus erythematosus, but in most cases can be identified and managed. Several of these risks (eg, lymphoma and serious infections) are associated with either the condition per se or the concomitant medication use. Simple screening procedures help manage the risk of tuberculosis infection; however, it is recommended that physicians and patients be alert to the development of any new infection so that appropriate treatment may be initiated promptly. Rare infusion reactions, particularly with infliximab, may also be effectively managed.
Conclusion:
TNF-blockers are effective and may be safely used for short- and long-term management of RA or CD. TNF-blockers also show efficacy in other emerging indications.
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