Antitumor necrosis factor therapy for Inflammatory Bowel Disease: A review of agents, pharmacology, clinical results, and safety

William J. Sandborn*, Stephen B. Hanauer

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

415 Scopus citations

Abstract

Tumor necrosis factor-α (TNFα), a proinflammatory cytokine, plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Biotechnology agents including a chimeric monoclonal anti-TNF antibody (infliximab), a humanized monoclonal anti-TNF antibody (CDP571), and a recombinant TNF receptor fusion protein (etanercept) have been used to inhibit TNFα activity. Controlled trials have demonstrated efficacy for infliximab in moderately to severely active Crohn's disease (CD) and fistulizing CD sufficient to justify recent U.S. Food and Drug Administration (FDA) approval. Additional trials have been completed in rheumatoid arthritis (RA). Similarly, preliminary controlled trials have suggested efficacy for CDP571 in active CD and RA. Larger controlled trials have demonstrated efficacy for etanercept in RA patients who have failed disease modifying antirheumatic drug (DMARD) therapy leading to FDA approval for RA. Toxicities observed with anti-TNF therapies have included formation of human antichimeric antibodies (HACA) with associated acute and delayed hypersensitivity infusion reactions, human antihuman antibodies (HAHAs), and formation of autoantibodies with rare instances of drug-induced lupus. Several cases of non-Hodgkin's lymphoma also has been described. Future studies should evaluate optimal timing and duration of anti-TNF therapy, the utility of adjuvant medical treatments during anti-TNF therapy, and evaluate long-term safety and efficacy of the various anti-TNF agents.

Original languageEnglish (US)
Pages (from-to)119-133
Number of pages15
JournalInflammatory bowel diseases
Volume5
Issue number2
DOIs
StatePublished - May 1999

Keywords

  • Antibody Crohn's disease
  • Antitumor necrosis factor
  • CDP571
  • Etanercept
  • Infliximab
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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