CHRONIC INFLAMMATORY DISEASES AND ANTI-TNF BIOPHARMACEUTICALS
Biopharmaceuticals consisting of monoclonal antibodies and fusion proteins directed against cytokines or cell membrane receptors represent a breakthrough in the treatment of many chronic immunoinflammatory diseases. Among these are drugs that target human tumor necrosis factor-α (TNF). They have achieved a broad application in treating rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, juvenile idiopathic arthritis, chronic inflammatory bowel diseases, and others.
Good results and high remission rates in patients undergoing anti-TNF treatments have been demonstrated in numerous studies. As TNF has crucial physiological effects, TNF-neutralization is often accompanied by adverse reactions such as augmented susceptibility to infection. Clinical practice also shows a significant percentage of individuals who do not exhibit the desired response.
A possible explanation for secondary failure is the formation of anti-drug antibodies that neutralize anti-TNF drugs and/or promote clearance of these therapeutic proteins from the circulation. Anti-drug antibodies may also induce adverse effects through diverse immunological mechanisms.
The current article is an overview of currently used anti-TNF therapies in patients with chronic immunoinflammatory diseases, with emphasis on rheumatoid arthritis, and a brief description of considerations that are warranted in dental practice.