Treatment of rheumatoid arthritis with anti-TNF-alpha agents: A reappraisal

Roberto Caporali, Francesca Bobbio Pallavicini, Matteo Filippini, Roberto Gorla, Antonio Marchesoni, Ennio Giulio Favalli, Piercarlo Sarzi-Puttini, Fabiola Atzeni, Carlomaurizio Montecucco

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

It has been found that tumour necrosis factor(TNF)-alpha plays a pivotal role in the pathogenesis of rheumatoid arthritis (RA), and the development of drugs targeting this molecule has extended the therapeutical approaches to RA patients. A number of observational studies of large patient series have also been published over the last few years, many of which have been based on national registries designed to monitor the efficacy and safety of anti-TNF agents, and allow healthcare institutions to control expenditure. Registry data can also help in identifying clinical and laboratory findings capable of predicting response. It has been suggested that the percentage of responding patients is lower in everyday clinical practice than that observed in RCTs, possibly because of patient selection, the use of a washout period before inclusion (which may artificially increase disease activity), and differences in doses, co-morbidities and adherence to therapy. A number of safety concerns have been raised since the introduction of anti-TNF agents, and they are now contraindicated in patients with advanced heart failure; however, the most widely debated current issues regard infections and neoplastic diseases. Moreover, the marketing of new and expensive biological agents has made strictly necessary to create systems capable of monitoring their safety and effectiveness in everyday practice, including the use of longitudinal observational studies. As the first published registry of anti-TNFα-treated patients in Italy, Lombardy Rheumatology Network (LORHEN) is already making its contribution in this direction.

Original languageEnglish
Pages (from-to)274-280
Number of pages7
JournalAutoimmunity Reviews
Volume8
Issue number3
DOIs
Publication statusPublished - Jan 2009

Fingerprint

Rheumatoid Arthritis
Tumor Necrosis Factor-alpha
Registries
Safety
Observational Studies
Therapeutics
Biological Factors
Rheumatology
Drug Delivery Systems
Health Expenditures
Marketing
Patient Selection
Italy
Longitudinal Studies
Heart Failure
Morbidity
Delivery of Health Care
Infection

Keywords

  • Anti-tumour necrosis factor (TNF)
  • Disease modifying anti-rheumatic drugs (DMARDs)
  • Methotrexate (MTX)
  • Rheumatoid arthritis (RA)

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Treatment of rheumatoid arthritis with anti-TNF-alpha agents : A reappraisal. / Caporali, Roberto; Pallavicini, Francesca Bobbio; Filippini, Matteo; Gorla, Roberto; Marchesoni, Antonio; Favalli, Ennio Giulio; Sarzi-Puttini, Piercarlo; Atzeni, Fabiola; Montecucco, Carlomaurizio.

In: Autoimmunity Reviews, Vol. 8, No. 3, 01.2009, p. 274-280.

Research output: Contribution to journalArticle

Caporali, R, Pallavicini, FB, Filippini, M, Gorla, R, Marchesoni, A, Favalli, EG, Sarzi-Puttini, P, Atzeni, F & Montecucco, C 2009, 'Treatment of rheumatoid arthritis with anti-TNF-alpha agents: A reappraisal', Autoimmunity Reviews, vol. 8, no. 3, pp. 274-280. https://doi.org/10.1016/j.autrev.2008.11.003
Caporali, Roberto ; Pallavicini, Francesca Bobbio ; Filippini, Matteo ; Gorla, Roberto ; Marchesoni, Antonio ; Favalli, Ennio Giulio ; Sarzi-Puttini, Piercarlo ; Atzeni, Fabiola ; Montecucco, Carlomaurizio. / Treatment of rheumatoid arthritis with anti-TNF-alpha agents : A reappraisal. In: Autoimmunity Reviews. 2009 ; Vol. 8, No. 3. pp. 274-280.
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