Lessons learned in the use of tumor necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis

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Abstract
Tumor necrosis factor-alpha (TNFα) plays a central role in rheumatoid arthritis (RA) pathogenesis. There are cur-rently three available anti-TNFα agents for the treatment of RA—adalimumab, etanercept, and infliximab. These tar-geted therapies have select advantages over traditional disease-modifying antirheumatic drugs (DMARDs), agents that have long been the mainstay of RA treatment. Compared with conventional DMARDs, TNFα inhibitors display a rapid onset of action and have shown a significant effect in retarding the radiographic joint destruction that often char-acterizes RA disease progression. Although anti-TNFα drugs represent an important advance in RA treatment, postmarketing reports of serious infections, as well as other adverse events, highlight the need for continued postmarketing vigilance with the use of these agents. This review evaluates the unique attributes of the available TNFα inhibitors, focusing specifically on recent reports providing important insight into the understanding of drug-related efficacy and toxicity.

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