Safety of tumour necrosis factor and interleukin-1 blocking agents in rheumatic diseases
Section snippets
TNFα and IL-1 blocking agents in rheumatic diseases
Anticytokine agents and other biologic response modifiers represent an important advance in the treatment of chronic rheumatic autoimmune diseases.
TNFα blocking agents have been demonstrated, in placebo-controlled clinical trials, to be highly effective in the treatment of rheumatoid arthritis (RA) [1], [2], [3], psoriatic arthritis [4], ankylosing spondylitis (AS) [5], and juvenile rheumatoid arthritis [6]—disorders in which TNFα may have a significant role in pathogenesis.
IL-1 receptor
Safety of TNFα antagonists
TNFα is a central mediator of inflammation and immunity, and plays a crucial role in host defense. Inhibition of TNFα clearly predisposes to certain infections, such as granulomatous infections like tuberculosis (TB) [8]. Inhibition of TNFα may also play a role in autoimmunity although the pathophysiologic mechanisms are uncertain [9].
The role of TNFα in carcinogenicity and tumor surveillance has not been completely established. Early cell culture studies indicated that TNFα is cytotoxic for
Safety of anakinra
Injection site reactions (ISRs) were the only adverse event clearly associated with anakinra treatment, occurring in 64% of anakinra subjects compared to 27% of placebo subjects. ISRs occur more commonly among women. Most reactions appeared to be mild, and resolved within a few weeks. The most common reason for withdrawal is ISRs, occurring in 5.6% of anakinra subjects [17].
Although some subjects had evidence of anti-anakinra antibodies, the appearance of potentially neutralizing antibodies was
Clinical use of TNFα and IL-1 blocking agents
TNFα antagonists appear to be among the most effective treatments available for RA, AS and psoriatic arthritis. The response is generally rapid, often occurring within a few weeks, although not all patients have a response.
TNFα antagonists are finding a place in the treatment of other rheumatic conditions, such as Still's disease, uveitis, and vasculitis.
Anti-TNFα therapy should not be started in patients with active infection and should be discontinued if a serious infection occurs. Chronic or
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2023, International ImmunopharmacologyEffectiveness and tuberculosis-related safety profile of interleukin-1 blocking agents in the management of Behçet's disease
2015, Autoimmunity ReviewsCitation Excerpt :In conclusion, IL-1 targeting treatments have confirmed a good safety profile consistent with previous studies, albeit on small samples of patients [111–117]. All these data indicate that blocking the IL-1 pathway is safer in comparison with blocking TNF-α [118,119], suggesting the benefit of anti-IL-1 agents in those geographical areas where tuberculosis is a social concern [120,121]. BD represents a prototype complex syndrome in which the wide variability in clinical manifestations is mirrored by the experimental evidence pointing towards an autoimmune/autoinflammatory etiology based on a strong genetic susceptibility.
Controlling inflammation. Contemporary treatments for autoinflammatory diseases and syndromes.
2013, Dermatologic ClinicsCanakinumab in Schnitzler Syndrome
2013, Seminars in Arthritis and RheumatismCitation Excerpt :Moreover, injection-site reactions are frequent and sometimes severe. Neutropenia is another concern, mandating monitoring of neutrophil counts (7). Recently, the first experience with Rilonacept, another interleukin-1 antagonist, in Schnitzler syndrome was published.
Methods used to assess remission and low disease activity in rheumatoid arthritis
2010, Autoimmunity ReviewsCitation Excerpt :The progressive clarification in the pathogenesis of Rheumatoid arthritis (RA) and the subsequent biopharmaceutical discoveries, led to the establishment of more effective medications [1–3]. Indeed, successful long term use of biological agents require ongoing monitoring to avoid drug toxicity [4–7]. However, since biologic response modifiers have been proved to markedly reduce signs and symptoms of the disease, better outcomes are expected, and reported.