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Authors Garry M Walsh

Published 15 March 2007 Volume 2007:3(1) Pages 1—2

Garry M Walsh

Asthmatic and Allergic Inflammation Group, School of Medicine, University of Aberdeen, UK

This issue of Therapeutics and Clinical Risk Management contains two interesting and thorough review articles on the use of anti-tumor necrosis factor (TNF) monoclonal antibodies (mAb) in the treatment of rheumatoid arthritis and related disorders. The arthritic diseases and distressing conditions associated with significant morbidity are typified by reductions in functional capacity and quality of life with attendant substantial healthcare expenditure. Development of specifically targeted biological agents in recent years has greatly enhanced the therapeutic options for the treatment of the arthritic diseases such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. TNF is an attractive biological target as it has been implicated as a major pro-inflammatory player in a wide range of other conditions, in addition to the arthritic diseases, including inflammatory bowel disease (D’Haens and Daperno 2006), asthma (Cazzola and Polosa 2006), and other autoimmune diseases (Chatzantoni and Mozaki 2006). Levels of TNF are elevated in the relevant sites of inflammation in these conditions; eg, in the synovial fluid and sera of patients with active rheumatoid arthritis. TNF is a potent osteogenic cytokine and is the central mediator of inflammation and joint destruction in rheumatoid arthritis. Three TNF antagonists are currently available: infliximab, a chimeric anti-TNF mAb; adalimumab, a fully human anti-TNF mAb; and etanercept, a recombinant soluble p75 TNF-receptor-Fc fusion protein. Although there are no clinical studies that directly compare etanercept, infliximab, or adalimumab in the treatment of rheumatoid arthritis, data from noncomparative trials suggest that all have similar therapeutic efficacy.

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