What are tumour necrosis factor inhibitors?
Tumour necrosis factor (TNF) is a cytokine associated with inflammatory disorders of the skin, joints, and gastrointestinal tract.
The most active tumour necrosis factor inhibitors (anti-TNF drugs) are monoclonal antibodies targeted against TNF-alpha (TNFα). Anti-TNFα drugs control inflammation in inflammatory skin diseases, arthritis, and bowel disease. They were among the first biologic agents on the market.
Anti-TNFα monoclonal antibodies include:
Other compounds with anti-TNF activity
Other drugs with activity against TNF include:
Natural compounds acting against TNF include:
What skin conditions are tumour necrosis factor inhibitors used to treat?
The anti-TNF monoclonal antibodies are used mainly in the treatment of severe chronic plaque psoriasis.
They are also used for other severe inflammatory skin diseases when conventional therapies have failed. Examples include:
- Hidradenitis suppurativa
- Skin disease associated with Crohn disease
- Pyoderma gangrenosum and PAPA syndrome (off-label).
Skin conditions treated with tumour necrosis factor inhibitors
What are the risks of tumour necrosis factor inhibitors use?
Anti-TNF biologics are given by injection. They can sometimes cause injection site reactions or infusion reactions.
They should be avoided in patients with severe heart failure.
The main risk of anti-TNF therapy is reduced immunity to bacterial, fungal, viral, and parasitic infections, including:
Anti-TNF medicines can lose their effect over time, possibly because of the induction of antibodies against them.
Paradoxically, anti-TNF drugs can sometimes have dermatological side effects, such as:
- Palmoplantar pustulosis
- Various forms of paradoxical psoriasis
- Lupus erythematosus
- Alopecia areata
- Drug-induced vitiligo
- Granuloma annulare
- Erythema multiforme
- Stevens-Johnson syndrome — toxic epidermal necrolysis
- Drug-induced nummular dermatitis
Dermatological side effects of tumour necrosis factor inhibitors
We suggest you refer to your national drug approval agency such as the Australian Therapeutic Goods Administration (TGA), US Food and Drug Administration (FDA), UK Medicines and Healthcare products regulatory agency (MHRA) / emc, and NZ Medsafe, or a national or state-approved formulary eg, the New Zealand Formulary (NZF) and New Zealand Formulary for Children (NZFC) and the British National Formulary (BNF) and British National Formulary for Children (BNFC).