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03-05-2022 | Etanercept | Review

The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era

Authors: Gerasimos Evangelatos, Giorgos Bamias, George D. Kitas, George Kollias, Petros P. Sfikakis

Published in: Rheumatology International | Issue 9/2022

Abstract

Since the late 1990s, tumor necrosis factor alpha (TNF-α) inhibitors (anti-TNFs) have revolutionized the therapy of immune-mediated inflammatory diseases (IMIDs) affecting the gut, joints, skin and eyes. Although the therapeutic armamentarium in IMIDs is being constantly expanded, anti-TNFs remain the cornerstone of their treatment. During the second decade of their application in clinical practice, a large body of additional knowledge has accumulated regarding various aspects of anti-TNF-α therapy, whereas new indications have been added. Recent experimental studies have shown that anti-TNFs exert their beneficial effects not only by restoring aberrant TNF-mediated immune mechanisms, but also by de-activating pathogenic fibroblast-like mesenchymal cells. Real-world data on millions of patients further confirmed the remarkable efficacy of anti-TNFs. It is now clear that anti-TNFs alter the physical course of inflammatory arthritis and inflammatory bowel disease, leading to inhibition of local and systemic bone loss and to a decline in the number of surgeries for disease-related complications, while anti-TNFs improve morbidity and mortality, acting beneficially also on cardiovascular comorbidities. On the other hand, no new safety signals emerged, whereas anti-TNF-α safety in pregnancy and amid the COVID-19 pandemic was confirmed. The use of biosimilars was associated with cost reductions making anti-TNFs more widely available. Moreover, the current implementation of the “treat-to-target” approach and treatment de-escalation strategies of IMIDs were based on anti-TNFs. An intensive search to discover biomarkers to optimize response to anti-TNF-α treatment is currently ongoing. Finally, selective targeting of TNF-α receptors, new forms of anti-TNFs and combinations with other agents, are being tested in clinical trials and will probably expand the spectrum of TNF-α inhibition as a therapeutic strategy for IMIDs.

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Title: The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era
Authors: Gerasimos Evangelatos
Giorgos Bamias
George D. Kitas
George Kollias
Petros P. Sfikakis
Publication date: 03-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Etanercept
Infliximab
Chronic Inflammatory Bowel Disease
Adalimumab
Arthritis
COVID-19
Rheumatoid Arthritis
Biomarkers
Published in: Rheumatology International / Issue 9/2022
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-022-05136-x

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Assessment of TNF-α expression in unstable atherosclerotic plaques, serum IL-6 and TNF-α levels in patients with acute coronary syndrome and rheumatoid arthritis

Assessment of autonomic dysfunction with the COMPASS-31 and its relationship with disease activity and cardiovascular risks in patients with psoriatic arthritis

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