oa SA Pharmaceutical Journal - Adverse effects and other issues with the use of anti-TNF therapy : medifile : clinical review
In our previous article, we outlined the pathophysiology of inflammatory diseases and mechanisms to inhibit the inflammatory mediators, one of which is TNF-alpha. The nomenclature and characteristics of the TNF-alpha inhibitors,a biological class of drugs, were also reviewed. In addition, the clinical application of these drugs in various inflammatory conditions was discussed.
In this article, the second in the series, adverse effects and toxicities of the TNF blockers are investigated, in particular tuberculosis and the controversy over malignancy. Furthermore, we focus on the induction of autoimmunity caused by the anti-TNFs. Neutralising antibody formation, which may cause a decrease in the effectiveness of some of these drugs, is a specific problem, but may be reduced by various strategies.
Lastly, we look at issues around which anti-TNF drug to select, as well as the appropriateness of switching from one to another in patients where a particular TNF blocker does not show adequate or sustained clinical benefit.
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