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Anti-TNF-α agents in the treatment of immune-mediated inflammatory diseases: mechanisms of action and pitfalls

    Léia CR Silva*

    Laboratory of Dermatology & Immunodeficiencies, Dermatology Division, Clinics Hospital, São Paulo, Brazil

    *These authors contributed equally to this work

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    ,
    Luciena CM Ortigosa*

    Laboratory of Dermatology & Immunodeficiencies, Dermatology Division, Clinics Hospital, São Paulo, Brazil

    *These authors contributed equally to this work

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    &
    Gil Benard

    † Author for correspondence

    Laboratory of Medical Mycology, Tropical Medicine Institute, University of São Paulo Medical School, São Paulo, Brazil: R Dr Eneas de Carvalho Aguiar 470, Instituto de Medicina Tropical (IMT), Cerqueira Cesar, São Paulo, SP, 05403 903, Brazil.

    Published Online:https://doi.org/10.2217/imt.10.67

    TNF-α is a potent inducer of the inflammatory response, a key regulator of innate immunity and plays an important role in the regulation of Th1 immune responses against intracellular bacteria and certain viral infections. However, dysregulated TNF can also contribute to numerous pathological situations. These include immune-mediated inflammatory diseases (IMIDs) including rheumatoid arthritis, Crohn’s disease, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis and severe chronic plaque psoriasis. Animal and human studies concerning the role of TNF-α in IMIDs have led to the development of a therapy based on TNF blockage. This article focuses first on the potential mechanisms by which the three currently licensed agents, adalimumab, etarnecept and infliximab, decrease the inflammatory activity of patients with different IMIDs. Second, it focuses on the risks, precautions and complications of the use of TNF-α inhibitors in these patients.

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