TNF-alpha Inhibitors

Over the last decade, the advent of biologic agents has greatly revolutionized therapeutic medicine in the management of chronic inflammatory diseases, such as rheumatoid arthritis, Crohn’s disease, and psoriasis. Elucidation of the complex web of cytokine network and the roles of these cytokines in the pat- genesis of inflammatory disorders provided one of the key catalysts for the advancement of targeted biologic therapy in autoimmune and inflammatory diseases. TNF-? is known to play a crucial role in the pathogenesis of many chronic inflammatory diseases. Elevated levels of TNF-? have been demonstrated in Crohn’s disease, psoriasis, psoriatic arthritis, and rheumatoid arthritis, sugge- ing a role for TNF-? in their pathogenesis. Although TNF-? plays a critical role in the activation of innate and acquired immune responses, the persistence of the immune response and inappropriate production of TNF-? can produce pathological changes resulting from chronic inflammation and tissue damage. The purpose of this volume is to provide a comprehensive overview of the development, pharmacology, efficacy, and safety of the currently available TNF-? inhibitors – etanercept, infliximab, and adalimumab. The initial three chapters of the volume provide a background on the field on TNF-? and its inhibition. Chapter 1 provides an introduction to TNF and reviews the pathophysiology of this cytokine. Chapter 2 then presents the h- tory of the development of TNF inhibitors. The pharmacology of these agents is reviewed in Chapter 3.