[Value of anti-TNF-alpha molecules in inflammatory and infectious diseases]

Complicaciones infecciosas asociadas al uso de fármacos antagonistas del factor de necrosis tumoral. Revisión de conjunto

Treatment with tumor necrosis factor antagonists (anti-TNF) is an innovative therapeutic approach that requires supervised administration by specialists in rheumatology and inflammatory diseases. Collaboration by infectious diseases consultants with expertise in these biological therapies is crucial to detect the development of one of the most frequent and fearsome associated adverse events: infections, particularly, tuberculosis. The tasks of these specialists include screening for tuberculosis prior to anti-TNF therapy, recommending prophylactic measures, detecting latent tuberculosis and avoiding its reactivation, and assessing potential risk and benefits before starting anti-TNF therapy. Moreover, close follow-up of on-treatment patients is mandatory to achieve early diagnosis and treatment of any infectious event caused by bacteria, fungi or mycobacteria.

[Anti-TNF-alpha monoclonal antibodies in the treatment of rheumatoid arthritis]

INTRODUCTION

Current slow-acting anti-rheumatic drugs available for rheumatoid arthritis can fail for certain severe cases; some are used empirically. Improvements in our knowledge of its pathogenesis and advances in molecular biology have made it possible to develop partially selective immunotherapy approaches.

CURRENT KNOWLEDGE AND KEY POINTS

Tumor necrosis factor-alpha (TNF-alpha) is a critical inflammatory mediator in rheumatoid arthritis and may therefore be a useful target for specific immunotherapy. This article summarizes clinical studies using anti-TNF-alpha antibodies. It appears that there is good evidence for both safety and beneficial effects of anti-TNF-alpha antibodies in short-term treatment of rheumatoid arthritis.

FUTURE PROSPECTS AND PROJECTS

It remains to be determined whether specific blockade of a single inflammatory mediator may be useful in long-term management. Therapeutic strategies aimed at concomitantly interfering with multiple pathogenic pathways are currently under investigation.