How far has anti-TNFα therapy advanced in treating rheumatoid arthritis (RA)? This comprehensive review explores the rationale, efficacy, and safety of anti-TNFα therapy in RA, drawing on clinical investigations and randomized, placebo-controlled trials. The authors discuss the role of TNFα in regulating pro-inflammatory cytokines and its impact on joint inflammation and damage. Clinical investigations provided evidence that TNF regulates IL-6, IL-8, MCP-1, and VEGF production, recruitment of immune and inflammatory cells into joints, angiogenesis, and reduction of blood levels of matrix metalloproteinases-1 and -3. Systemic administration of anti-TNFα antibody or sTNFR fusion protein to mouse models of RA was shown to be anti-inflammatory and joint protective. The study concludes that TNFα inhibitors have demonstrated consistent and remarkable efficacy in controlling signs and symptoms in RA patients, with a favorable safety profile for up to 2 years. The approval of infliximab and etanercept represents a significant addition to therapeutic options for RA.
Published in the Annual Review of Immunology, this article directly aligns with the journal's focus on immunological research and its applications in treating immune-mediated diseases. This paper focuses on Anti-TNFα, and it fits with the journal's audience of immunologists and clinicians.