FOCUS ON: Biologics that Affect Therapeutic Agents in Dermatology
March 2005 | Volume 4 | Issue 2 | Features | 233 | Copyright © March 2005
Yamini V. Saripalli MD, Anthony A. Gaspari MD
Tumor necrosis factor (TNF)-α is one of the oldest known cytokines in human physiology. It is involved in both normal and pathologic
states. Virtually every cell and organ in the body are affected by TNF-α.1
Though TNF-α is usually involved in inflammation
as a normal host defense response, when overproduced, it can become pathologic and affect almost every organ system. In
this article, we address the role of TNF-α in diseases such as rheumatoid arthritis, Crohn's disease, psoriasis, and ankylosing
spondylitis as well as the drugs used to modulate TNF-α. Specifically, we look at the structure, mechanism of action, and clinical
use for etanercept, infliximab, and adalimumab. Historically, we also review the drug lenercept, another TNF-α modulator. These
drugs offer alternative effective treatments to rheumatologic and dermatologic diseases without as many of the toxic side effects of
some of the traditional therapies. The traditional agents target TNF-α in addition to several other modes of action (disease modifying
anti-rheumatic drugs [DMARDS] such as cyclosporine and methotrexate) (Table 1).
Though TNF-α immunomodulation seems to be a very effective, promising treatment in several TNF-α mediated disease processes,
long-term studies need to be performed to assess the risk-benefit ratio of using these drugs over an extended period of time.